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April 19, 1965

Alternate-Day Steroid Therapy For Nephrotic Children

Author Affiliations

From the Children's Service, Massachusetts General Hospital, and the Department of Pediatrics, Harvard Medical School, Boston.

JAMA. 1965;192(3):225-230. doi:10.1001/jama.1965.03080160045012

Prolonged high-dosage steroid therapy is recognized as the treatment of choice in the management of childhood nephrosis. It substantially reduces morbidity and mortality and produces a definite improvement in prognosis. Unfortunately, such therapy is accompanied not only by the clinical stigmata of hyperadrenocorticism, but also by cessation of growth, convulsions, hypertension, osteoporosis, and gastrointestinal bleeding.

A program which was effective, yet minimized these untoward reactions to prolonged steroid therapy, would constitute a major therapeutic advance. The results of intermittent corticosteroid treatment of adults with asthma and a variety of other clinical conditions reported by Harter et al1 were therefore of great interest. They found a reduction in the incidence and severity of side effects when a single dose of prednisone, equal to the two-day requirement, was given every 48 hours. The 48-hour interval was necessary because intervals between doses of 12, 24, and 36 hours were accompanied by adrenal