Optimizing prednisone dosing in pediatric nephrotic syndrome: body weight vs. body surface area

Background and objectives. Scholars have long debated whether a prednisone dosing in children with nephrotic syndrome (NS) should be based on body weight (BW) or body surface area (BSA). This study aimed to evaluate and compare the effectiveness and safety of these two dosing strategies in the management of pediatric NS. Materials and methods. A systematic review and meta-analysis comparing BW-based and BSA-based prednisone dosing in children with nephrotic syndrome was conducted in accordance with the PRISMA 2020 guidelines. The study was registered in the International Prospective Register of Systematic Reviews (PROSPERO; registration number CRD42024529301). Rigorous screening, data extraction, and risk of bias assessment were performed, followed by statistical analysis using RevMan version 5.3. Results. A total of 452 articles were initially retrieved from online databases (PubMed, SagePub, Nature, and Cochrane). After screening, five eligible studies involving 285 children were included in the final analysis. The meta-analysis showed that BW-based dosing tended to result in lower cumulative steroid use compared with BSA-based dosing; however, the difference was not statistically significant (pooled mean difference [MD]: –16.09; 95% CI: –49.92 to 17.74; p = 0.35). For time to remission, BSA-based dosing was slightly more favorable (MD: 1.06; 95% CI: –0.07 to 2.19; p = 0.07). Relapse rates were comparable between the two groups (odds ratio [OR]: 1.00; 95% CI: 0.52–1.91; p = 1.00). Although adverse events were more frequent in the BSA-based group, the difference in incidence was not statistically significant (OR: 0.71; 95% CI: 0.39–1.26; p = 0.24). Conclusions. BW-based and BSA-based prednisone regimens demonstrate similar efficacy, remission rates, and relapse rates in children with nephrotic syndrome. While BW-based dosing appears to be associated with fewer adverse events and lower cumulative steroid exposure, these differences were not statistically significant.