Table 3.

Therapy procedures for children, modified by KDIGO 2012 (43), Prof. Arvind Bagga, and authors’ clinical experience

TherapyUnited States 2009India 2008France 2008KDIGO 2012Italy 2016 (SINePe Recommendations in Preparation)
PDN at onset2 mg/kg per d, 6 wk2 mg/kg per d, 6 wk60 mg/m2 per d, 4 wk60 mg/m2 per d (or 2 mg/kg per d), 4–6 wk60 mg/m2 per d, 6 wk
1.5 mg/kg every other d1.5 mg/kg every other d60 mg/m2 every other d40 mg/m2 every other d (or 1.5 mg/kg every other d), 2–5 mo, taper40 mg/m2 every other d, 6 wk
6 wk, no taper6 wk, no taper8 wk, taperMinimum duration 12 wkNo taper
Duration 12 wkDuration 12 wkDuration 18 wkDuration 12 wk
PDN in relapse (first relapses, NRNS)2 mg/kg per d until 3 d after remission; 1.5 mg/kg every other d2 mg/kg per d until 3 d after remission60 mg/m2 per d until 6 d after remission60 mg/m2 per d (or 2 mg/kg per d) until 3 d after remission60 mg/m2 per d until 5 d after remission
4 wk, no taper1.5 mg/kg every other d, 4 wk, no taper60 mg/m2 every other d, 4 wk, taper40 mg/m2 every other d (or 1.5 mg/kg every other d), 4 wk40 mg/m2 every other d, 4 wk
No taperNo taper
Long-term PDN (FRNS or SDNS)2 mg/kg per d until 3 d after remission2 mg/kg per d until 3 d after remission60 mg/m2 per d until 6 d after remission60 mg/m2 per d (or 2 mg/kg per d) until 3 d after remissionNot yet available
1.2 mg/kg every other d, 4 wk1.2 mg/kg every other d, 4 wk60 mg/m2 every other d, 4 wk40 mg/m2 every other d (or 1.5 mg/kg every other d)
Taper by 0.5 mg/kg every other d over 2 moTaper by 0.5–0.7 mg/kg every other dTaper by 15 mg/m2 every other d, every 2 wk up to 15 mg/m2 every other d, continue for 12–18 moTaper over ≥3 mo
Continue for 9–18 moLowest every other d or daily dose to maintain remission
Steroid-sparing agents (FRNS or SDNS)FRNS: CPA 12 wkLev 1–2 yrLevCPA 8–12 wkNot yet available
MMF 1–2 yrCPA 12 wkCPAChlorambucil 8 wk
CsA/TAC 2–5 yrCsA/TAC 1–2 yrCsALev>1 yr
SDNS: CsA/TACMMF 1–2 yrMMFCsA/TAC>1 yr
MMFMMF>1 yr
CPARituximab
  • KDIGO, Kidney Disease Improving Global Outcomes; SINePe, Società Italiana Nefrologia Pediatrica; PDN, prednisone; NRNS, nonrelapsing nephrotic syndrome; FRNS, frequently relapsing nephrotic syndrome; SDNS, steroid-dependent nephrotic syndrome; CPA, cyclophosphamide; Lev, levamisole; MMF, mofetil mycophenolate; CsA, cyclosporine A; TAC, tacrolimus.