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Background <p>Corticosteroids remain the cornerstone of therapy for steroid-sensitive nephrotic syndrome (SSNS), yet the optimal dosing strategy, single daily versus divided doses, remains uncertain.</p> Methods <p>We conducted a systematic review of studies comparing once-daily and divided-dose prednisolone in children with SSNS. Three randomized controlled trials and one non-randomized study were included, enrolling a total of 288 patients. Primary outcomes were time to remission and relapse frequency; secondary outcomes included hypothalamic–pituitary–adrenal (HPA) axis suppression and adverse events.</p> Results <p>Overall, remission rates were comparable between single and divided dosing. In relapse settings, one trial showed faster remission with split dosing (by 1–2&#xa0;days), though without differences in relapse frequency or safety. In first-episode disease, single daily dosing was associated with less HPA axis suppression and a longer time to first relapse. Adverse event profiles were similar across regimens.</p> Conclusions <p>Single-dose and split-dose prednisolone regimens&#xa0;demonstrate&#xa0;comparable remission efficacy in children with SSNS. Divided dosing may shorten remission by 1–2&#xa0;days during relapse episodes, but this small benefit must be weighed against the greater HPA-axis suppression&#xa0;observed&#xa0;with multi-dose schedules. Given the heterogeneity and small sample sizes of available trials, the current evidence&#xa0;remains&#xa0;insufficient to&#xa0;establish&#xa0;superiority. Larger multicenter RCTs with standardized protocols and longer follow-up are needed to&#xa0;provide&#xa0;more definitive guidance.</p> Graphical abstract <p>A higher resolution version of the Graphical abstract is available as <InternalRef RefID="MOESM1">Supplementary information</InternalRef></p> <p></p>

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Single-dose versus multi-dose steroid therapy in pediatric nephrotic syndrome: a systematic review and meta-analysis

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年2月28日

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  • Candela Romano,
  • Lisyareli Salazar Arriaga,
  • Linda Estefania Cordero Velez,
  • Alexandra Melendez Delgado,
  • Tatiana Alexandra Moreno Díaz,
  • Haya Al Shakkakee,
  • Abhigna Reddy Kudumula,
  • Steysi Connie Falcon Aragon,
  • Ernesto Calderon Martinez

摘要

Background

Corticosteroids remain the cornerstone of therapy for steroid-sensitive nephrotic syndrome (SSNS), yet the optimal dosing strategy, single daily versus divided doses, remains uncertain.

Methods

We conducted a systematic review of studies comparing once-daily and divided-dose prednisolone in children with SSNS. Three randomized controlled trials and one non-randomized study were included, enrolling a total of 288 patients. Primary outcomes were time to remission and relapse frequency; secondary outcomes included hypothalamic–pituitary–adrenal (HPA) axis suppression and adverse events.

Results

Overall, remission rates were comparable between single and divided dosing. In relapse settings, one trial showed faster remission with split dosing (by 1–2 days), though without differences in relapse frequency or safety. In first-episode disease, single daily dosing was associated with less HPA axis suppression and a longer time to first relapse. Adverse event profiles were similar across regimens.

Conclusions

Single-dose and split-dose prednisolone regimens demonstrate comparable remission efficacy in children with SSNS. Divided dosing may shorten remission by 1–2 days during relapse episodes, but this small benefit must be weighed against the greater HPA-axis suppression observed with multi-dose schedules. Given the heterogeneity and small sample sizes of available trials, the current evidence remains insufficient to establish superiority. Larger multicenter RCTs with standardized protocols and longer follow-up are needed to provide more definitive guidance.

Graphical abstract

A higher resolution version of the Graphical abstract is available as Supplementary information