Low-Dose Prednisolone for the Prevention of Recurrent Relapses in Nephrotic Syndrome Triggered by Regular Hospital Visits: A Case Report

Hospital visits causing psychological stress can trigger nephrotic syndrome relapse in children. While there are reports on preventing relapse during respiratory infections by using low-dose steroids, no reports exist on preventing relapse from other triggers. We describe a case of a patient with repeated relapses triggered by regular hospital visits, which were successfully prevented by administering low-dose prednisolone before the visits. A 14-year-old boy with steroid-dependent nephrotic syndrome was referred and started on mycophenolate mofetil. During the following 14 months, there were nine regular hospital visits. Up to the third of four relapses, urinary proteins appeared on the day of the hospital visit and five and three days before the hospital visit. He experienced two instances of transient proteinuria, with positive urine protein test results on the day of a regular visit. Regular hospital visits were judged to trigger a relapse. At age 16, he was started on prednisolone at 20 mg (approximately 15 mg/m² or 0.5 mg/kg) for prophylaxis five days before regular hospital visits. Thereafter, he no longer experienced relapse or transient proteinuria. However, at age 19, he experienced a relapse related to a hospital visit despite prophylaxis with prednisolone. Since regular hospital visits were discontinued and he was placed under the regular care of a local doctor, prophylactic administration of prednisolone before hospital visits was discontinued. Thereafter, the mycophenolate mofetil dose was tapered off when he was 20 years old. He did not experience a relapse again until age 23. The case shows that low-dose prednisolone administration can prevent hospital visit-related relapse as well as relapse during respiratory infections.