Top

Pediatric Nephrology

Published in:

01-04-2019 | Original Article

Equations to estimate prednisone dose using body weight

Authors: Francesco Emma, Giovanni Montini, Antonio Gargiulo

Published in: Pediatric Nephrology | Issue 4/2019

Abstract

Background

In the clinical practice, prednisone (PDN) dose in children is often prescribed using the patient weight, despite dose calculation using body surface area (BSA) is assumed to be preferable, because it parallels better with PDN metabolism in human subjects.

Methods

Calculations based on body weight (W) carry the risk of underdosing, particularly in young children. Conversely, BSA estimation requires knowing the patient height, which is not always available, and more complex calculations.

Results

To overcome these limitations, we have developed linear equations allowing approximating the BSA-based dose using only the patient weight in kilogram. To this end, we have used anthropomorphic data from 754 pediatric patients and have validated the proposed equations with a prospective cohort of 77 children with steroid sensitive nephrotic syndrome. The equation estimating a dose of 60 mg/m² was [2 × W + 8] and the equation estimating a dose of 40 mg/m² was [W + 11].

Conclusions

Both equations performed very well and predicted reliably the BSA-based dose with an average error of 3.4% and 2.2%, respectively.

Available only for authorised users

International Study of Kidney Disease in Children (1979) Nephrotic syndrome in children: a randomized trial comparing two prednisone regimens in steroid-responsive patients who relapse early. J Pediatr 95:228–233

Hahn D, Hodson EM, Willis NS, Craig JC (2015) Corticosteroid therapy for nephrotic syndrome in children. Cochrane Database Syst Rev 3:CD001533. https://doi.org/10.1002/14651858

Lombel RM, Gipson DS, Hodson EM, Kidney Disease: Improving Global O (2013) Treatment of steroid-sensitive nephrotic syndrome: new guidelines from KDIGO. Pediatr Nephrol 28:415–426CrossRefPubMed

Vivarelli M, Massella L, Ruggiero B, Emma F (2017) Minimal change disease. Clin J Am Soc Nephrol 12:332–345CrossRefPubMed

Feber J, Al-Matrafi J, Farhadi E, Vaillancourt R, Wolfish N (2009) Prednisone dosing per body weight or body surface area in children with nephrotic syndrome: is it equivalent? Pediatr Nephrol 24:1027–1031CrossRefPubMed

Ruggiero B, Vivarelli M, Gianviti A, Benetti E, Peruzzi L, Barbano G, Corona F, Ventura G, Pecoraro C, Murer L, Ghiggeri GM, Pennesi M, Edefonti A, Coppo R, Emma F (2013) Lupus nephritis in children and adolescents: results of the Italian Collaborative Study. Nephrol Dial Transplant 28:1487–1496CrossRefPubMed

Vivarelli M, Moscaritolo E, Tsalkidis A, Massella L, Emma F (2010) Time for initial response to steroids is a major prognostic factor in idiopathic nephrotic syndrome. J Pediatr 156:965–971CrossRefPubMed

Pasini A, Aceto G, Ammenti A, Ardissino G, Azzolina V, Bettinelli A, Cama E, Cantatore S, Crisafi A, Conti G, D'Agostino M, Dozza A, Edefonti A, Fede C, Groppali E, Gualeni C, Lavacchini A, Lepore M, Maringhini S, Mariotti P, Materassi M, Mencarelli F, Messina G, Negri A, Piepoli M, Ravaglia F, Simoni A, Spagnoletta L, Montini G, NefroKid Study G (2015) Best practice guidelines for idiopathic nephrotic syndrome: recommendations versus reality. Pediatr Nephrol 30:91–101CrossRefPubMed

Mosteller RD (1987) Simplified calculation of body-surface area. N Engl J Med 317:1098PubMed

10.

Wang Y, Moss J, Thisted R (1992) Predictors of body surface area. J Clin Anesth 4:4–10CrossRefPubMed

11.

Haycock GB, Schwartz GJ, Wisotsky DH (1978) Geometric method for measuring body surface area: a height-weight formula validated in infants, children, and adults. J Pediatr 93:62–66CrossRefPubMed

12.

Gehan EA, George SL (1970) Estimation of human body surface area from height and weight. Cancer Chemother Rep 54:225–235PubMed

13.

Verbraecken J, Van de Heyning P, De Backer W, Van Gaal L (2006) Body surface area in normal-weight, overweight, and obese adults. A comparison study. Metabolism 55:515–524CrossRefPubMed

14.

Schimmer BP, Parker KL (2001) Adrenocorticotropic hormone; adrenocortical steroids and their synthetic analogs; inhibitors of the synthesis and actions of adrenocortical hormones. In: Gilman AG, Hardman JG, Limbird LE (eds) The pharmacological basis of therapeutics. The McGraw-Hill Companies, New York, pp 1635–1648

15.

Miura M, Satoh S, Inoue K, Kagaya H, Saito M, Inoue T, Habuchi T, Suzuki T (2008) Influence of CYP3A5, ABCB1 and NR1I2 polymorphisms on prednisolone pharmacokinetics in renal transplant recipients. Steroids 73:1052–1059CrossRefPubMed

16.

Sandrini R, Jospe N, Migeon CJ (1993) Temporal and individual variations in the dose of glucocorticoid used for the treatment of salt-losing congenital virilizing adrenal hyperplasia due to 21-hydroxylase deficiency. Acta Paediatr Suppl 388:56–60 discussion 61PubMed

17.

Raman V, Krishnamurthy S, Harichandrakumar KT (2016) Body weight-based prednisolone versus body surface area-based prednisolone regimen for induction of remission in children with nephrotic syndrome: a randomized, open-label, equivalence clinical trial. Pediatr Nephrol 31:595–604CrossRefPubMed

18.

Saadeh SA, Baracco R, Jain A, Kapur G, Mattoo TK, Valentini RP (2011) Weight or body surface area dosing of steroids in nephrotic syndrome: is there an outcome difference? Pediatr Nephrol 26:2167–2171CrossRefPubMed

Title: Equations to estimate prednisone dose using body weight
Authors: Francesco Emma
Giovanni Montini
Antonio Gargiulo
Publication date: 01-04-2019
Publisher: Springer Berlin Heidelberg
Published in: Pediatric Nephrology / Issue 4/2019
Print ISSN: 0931-041X
Electronic ISSN: 1432-198X
DOI: https://doi.org/10.1007/s00467-018-4127-8

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Equations to estimate prednisone dose using body weight

Abstract

Background

Methods

Results

Conclusions

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

Please log in to get access to this content

Other articles of this Issue 4/2019

Central systolic blood pressure and central pulse pressure predict left ventricular hypertrophy in hypertensive children

Correction to: An open-label, single-dose study to evaluate the safety, tolerability, pharmacokinetics, and pharmacodynamics of cinacalcet in pediatric subjects aged 28 days to < 6 years with chronic kidney disease receiving dialysis

Renal phosphate handling and inherited disorders of phosphate reabsorption: an update

Endovascular intervention in the maintenance and rescue of paediatric arteriovenous fistulae for hemodialysis

Effects of long-term cysteamine treatment in patients with cystinosis

Correlation between endocapillary proliferative and nephrotic-range proteinuria in children with Henoch-Schönlein purpura nephritis