Oral methylprednisolone versus prednisolone: A pilot randomised control trial in treatment of first episode nephrotic syndrome in children, non-inferiority trial

Nephrotic syndrome is the commonest glomerular disease in children. Corticosteroids are the first line treatment. Almost 80% shows steroid responsiveness and achieve complete remission in 4 weeks. Oral prednisolone for 8-12 weeks (as per KDIGO 2021 GUIDELINES) are used. Methyl prednisolone being a corticosteroid, with 1.25 times glucocorticoid effect and 0.625 times mineralocorticoid effect compared to prednisolone when given in equivalent dose can show low Na+ retention and there will be less chances of developing hypertension.

Considering lesser sodium retaining activity, methyl prednisolone might have lesser side effects as compared to prednisolone. The aim of this study is to compare the effectiveness and safety of methylprednisolone in children with first episode of idiopathic nephrotic syndrome in a prospective randomized controlled trial. Although studies on IV methylprednisolone have been done for treatment of primary nephrotic syndrome but study on oral methylprednisolone is limited.