Prednisolone 1mg/kg/day (max 60–80mg)

How it works

It binds intracellular glucocorticoid receptors to modulate transcription of inflammatory and immune genes, suppressing cytokine production, leucocyte activity and the immune injury underlying many glomerular diseases.

Prescribing in practice

• Do not stop prolonged or high-dose corticosteroid therapy abruptly because of the risk of adrenal crisis; the dose must be tapered and a steroid emergency card issued.
• Prolonged use causes hyperglycaemia, hypertension, osteoporosis, weight gain and increased infection risk, so gastroprotection, bone protection and infection vigilance should be considered.
• Live vaccines are generally contraindicated during significant immunosuppression, and chickenpox or measles exposure in a non-immune patient needs urgent attention.

Monitoring

Monitor blood pressure, blood glucose, weight, bone health and signs of infection, alongside the renal parameters guiding treatment response.

Counselling the patient

• Never stop the steroid suddenly and carry your steroid emergency card.
• Take it in the morning with food and report signs of infection.
• Tell any clinician you are taking steroids, especially if you become unwell.

Evidence & guidelines

Corticosteroids are a long-established mainstay of immune-mediated glomerular disease, with current prescribing references and the SPC underpinning their use and withdrawal rules.