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Corticosteroid (Oral)

Prednisolone 1mg/kg/day (max 60–80mg)

Brand names: Deltacortril, Predsol

Adult dose

Dose: Nephrotic syndrome induction: 1mg/kg/day (max 80mg) for 4–16 weeks, then taper. GN/vasculitis induction: 0.5–1mg/kg/day (max 60mg) as per protocol.
Route: Oral
Frequency: Once daily (morning — to minimise HPA axis suppression)
Max: 80mg/day (nephrotic syndrome); 60mg/day (GN/vasculitis)
Always use enteric-coated formulation (Deltacortril EC) for prolonged courses to reduce GI side effects. Taper schedule varies by indication and response — typically reduce by 5–10mg/week to 20mg, then more slowly. Gastroprotection with PPI mandatory for high-dose courses.

Paediatric dose

Dose: 2 mg/kg
Route: Oral
Frequency: Once daily
Max: 60mg/day (ISKDC protocol for nephrotic syndrome)
Concentration: 1 mg, 5 mg tablets; 1 mg/5 mL and 5 mg/5 mL oral solution mg/ml
ISKDC protocol for childhood nephrotic syndrome: prednisolone 2 mg/kg/day (max 60mg) for 4 weeks, then 1.5 mg/kg alternate days for 4 weeks. Relapses: 2 mg/kg OD until urine protein-free for 3 days, then taper. Specialist paediatric nephrology.

Dose adjustments

Renal

No dose adjustment required; monitor for fluid retention and hypertension in CKD

Hepatic

Caution in severe hepatic impairment — reduced prednisolone metabolism; active disease may alter distribution

Paediatric weight-based calculator

ISKDC protocol for childhood nephrotic syndrome: prednisolone 2 mg/kg/day (max 60mg) for 4 weeks, then 1.5 mg/kg alternate days for 4 weeks. Relapses: 2 mg/kg OD until urine protein-free for 3 days, then taper. Specialist paediatric nephrology.

Clinical pearls

  • ISKDC (International Study of Kidney Disease in Children) protocol: cornerstone of childhood nephrotic syndrome treatment — 90% remission rate with initial steroid course in minimal change disease
  • Bone protection is mandatory for courses >3 months: prescribe calcium + vitamin D (Calcichew D3 Forte) and consider bisphosphonate (risedronate/alendronate) if high-risk
  • Steroid-sparing agents (azathioprine, MMF, ciclosporin) indicated for frequent relapsers and steroid-dependent nephrotic syndrome
  • Sick day rules: double prednisolone dose during intercurrent illness or major surgery in patients on long-term treatment (adrenal suppression); supply steroid emergency card
  • Adrenal crisis risk: DO NOT stop prednisolone abruptly after >3 weeks — wean gradually (5–10mg/week reduction from high doses)

Contraindications

  • Systemic infection (untreated — treat infection first before starting immunosuppression)
  • Live vaccines during treatment
  • Hypersensitivity

Side effects

  • Cushingoid features (weight gain, moon face, striae) with prolonged use
  • Osteoporosis (long-term — prescribe bone protection)
  • Hyperglycaemia/steroid-induced diabetes
  • Hypertension
  • Cataracts and glaucoma
  • GI ulceration (use PPI with NSAIDs)
  • Adrenal suppression (do not stop abruptly after >3 weeks)
  • Increased infection susceptibility
  • Growth retardation (children)

Interactions

  • NSAIDs — additive GI ulceration risk
  • Rifampicin/carbamazepine/phenytoin — reduce prednisolone levels (CYP3A4 induction; double dose may be needed)
  • Ciclosporin — increased prednisolone levels
  • Antidiabetic agents — steroid-induced hyperglycaemia may require dose adjustment
  • Live vaccines — avoid (immunosuppression)

Monitoring

  • Blood glucose (weekly for first month at high doses)
  • Blood pressure
  • Urine protein (response assessment in nephrotic syndrome)
  • Bone density (DEXA) if >3 months use
  • Weight
  • Signs of infection

Reference: BNFc; BNF; ISKDC Protocol; KDIGO Nephrotic Syndrome Guidelines 2021; NICE Osteoporosis in corticosteroid users guidance. Verify against your local formulary and the latest BNF before prescribing.

Related

Curated clinical cross-links plus same-class fallbacks.

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