***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
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    Input: Abstract We have examined , in a prospect i ve r and omized controlled trial , the effect of 8- and 16-week initial steroid treatment on the course of idiopathic nephrotic syndrome ( INS ) . Patients with a first episode of INS were r and omized to receive st and ard 8-week prednisolone ( 2 mg/kg daily for 4 weeks , then 1.5 mg/kg on alternate days for 4 weeks ) or prolonged 16-week prednisolone treatment ( 2 and 1.5 mg/kg daily each for 4 weeks , then 1.5 and 1 mg/kg on alternate days each for 4 weeks ) . Relapses were treated with prednisolone , 2 mg/kg daily for 2 weeks , then 1.5 mg/kg on alternate days for 4 weeks . Of 45 patients , 23 received st and ard therapy and 22 prolonged therapy . The mean duration of follow-up was 29.2 and 27.3 months in the st and ard and prolonged treatment groups , respectively . The time to first relapse was longer in the prolonged treatment ( mean 222.2 days , median 120.0 days ) than the st and ard group ( mean 134.3 days , median 96.5 days ) . The percentage of patients with no relapse at 6 and 12 months after prednisolone withdrawal was 40.9 % and 27.3 % in the prolonged treatment and 21.7 % and 8.7 % in the st and ard groups , respectively . The inability to show statistically significant differences between the two groups was probably related to the small number of patients studied . Prolonged therapy did not affect the subsequent relapse rates and proportion of patients with frequent relapses and steroid dependence . The mean dose of prednisolone received , for the initial episode and relapses during the next year , was higher and associated with significant steroid toxicity in the prolonged treatment group . Our findings suggest that 16-week prednisolone treatment for the initial episode of INS may delay occurrence of the first relapse , but results in significant side effects . Prolongation of initial therapy may be useful in developing countries where frequent infections often induce early relapses Two regimens of steroid treatment for the initial attack of idiopathic nephrotic syndrome ( NS ) in children were compared in a controlled prospect i ve multicentre study . Long prednisone therapy consisted of 60 mg/m2 per 24 h for 6 weeks , followed by alternate day 40 mg/m2 per 48 h for 6 weeks . The st and ard prednisone therapy was 60 mg/m2 per 24 h for 4 weeks , followed by 40 mg/m2 per 48 h for 4 weeks . A total of 71 children with an initial attack of idiopathic NS were allocated at r and om to the two groups . The cumulative rate of patients with sustained remissions after 2 years was significantly higher after the long course than after the st and ard treatment ( 49 % vs 19%,P=0.0079 ) . The mean relapse rate per patient at intervals of 3 , 6 and 12 months was lower in the long-course prednisone group than in the st and ard prednisone group , and the proportion of children with frequent relapses during any subsequent 6 months period was lower in the long-course group than in the st and ard group ( 29 % vs 57%,P=0.03 ) . Mild side-effects of corticosteroid therapy were observed more frequently after long-course prednisone treatment . It is concluded that long-course prednisone therapy of the initial attack of steroid responsive NS is preferable to the st and ard regimen because it reduces the rate of subsequent relapses without increasing the risk for severe steroidal side-effects A total of 184 children aged , 13 months to 11 years , suffering from their first attack of steroid-responsive nephrotic syndrome were included in a r and omized study . They were treated according to three treatment protocol s. All children received 1 - 2 mg of prednisone/kg body weight/day ( up to 80 mg daily ) for 4 weeks , and thereafter 1 mg/kg body weight/48 h for the next 4 weeks . Treatment was discontinued at this point in 44 children ( protocol A ) ; in 68 ( protocol B ) the dose was reduced by 25 % each week , tapering off to 0 at the end of the third month , while in 72 children ( protocol C ) , after the first 2 months of initial treatment the dose was reduced by 25 % each month and tapered off to 0 by the end of the sixth month . All patients completed a 2-year follow-up period after withdrawal of prednisone . Treatment results were expressed as : percentage of children relapse-free within the first 6 months and 2 years after withdrawal of treatment , and average number of relapses per patient per year . The best results were obtained in children who had been treated for 6 months ; 65.3 % of them remained relapse-free within the first 6 months and 50 % over the entire 2-year follow-up period ; the number of relapses per patient per year in this group was 0.49 . The respective values for children treated 2 and 3 months were : 36.4 % and 32.4 % for the 6-month period ; 27.3 % and 20.6 % for the 2-year period ; the numbers of relapses per patient per year were 0.79 and 0.77 , respectively . ( ABSTRACT TRUNCATED AT 250 WORDS Ninety six patients aged from 6 months to 15 years and were admitted to Chilean hospitals with the diagnosis of primary nephrotic syndrome in a period of 30 months . These patients were r and omly separated in two groups , group A received prednisone for 8 weeks and group B received the same drug during 12 weeks . All patients were evaluated at 6 , 12 and 18 months after the end of treatment . The moment and number of relapses per patient , accumulated percentage of relapses , relapse rate per 100 patients , total number of relapses and complications were assessed . Frequent relapsers were subjected to a kidney biopsy , leaving in the protocol only those patients that had minimal changes . Patients resistant or dependent to steroid therapy were discarded . Thus we report the results of 56 treated patients followed during 18 months . No differences in analyzed parameters were observed between the two treatment groups . It is concluded that these preliminary results do not support the prolongation of prednisone treatment in children with primary nephrotic syndrome One hundred and fourteen children with primary nephrotic syndrome were followed up prospect ively for periods of between 5 and 14 years . Urine sample s from 94 of them became protein-free during the initial 8-week course of prednisone , and the outcome for these children was good : 74 of them have been free of symptoms for at least 3 years , 18 have had relapses during the last 3 years , and only one child still has proteinuria . All these children have normal renal function and blood pressure . One child died accidentally . Twenty children did not respond to the initial prednisone treatment . Thirteen of them had remissions later , of whom 2 have had relapses during the last 3 years . Seven were totally resistant to prednisone 4 of whom died in renal failure , the remaining 3 have persistent proteinuria with normal levels of creatinine ; one has high blood pressure too . Remission during the initial treatment indicated a good prognosis , but two-thirds of the initial non-responders also fared well BACKGROUND A long course of the initial prednisolone therapy has been shown to be more effective than st and ard-course therapy in reducing relapse rates in children with idiopathic nephrotic syndrome , but it is commonly accompanied by corticosteroid toxicities . There has been no study on prednisolone dosage for the effective treatment of nephrotic syndrome . METHODS Sixty-eight children ( 42 boys and 26 girls ) with an initial attack of nephrotic syndrome were r and omly allocated into two different long-course treatment groups . Patients in Group 1 received a daily prednisolone dose of 60 mg/m2 for six weeks , followed by an alternate-day dose of 40 mg/m2 for six weeks . Patients in Group 2 had a daily dose of 40 mg/m2 instead of 60 mg/m2 . RESULTS Four children in each group did not respond within six weeks . Group 1 was associated with a significantly earlier response but more frequent corticosteroid toxicities than Group 2 . Boys in Group 1 had a higher rate of sustained remission than boys in Group 2 ( P = 0.0073 ) , especially boys four years old or more ( P = 0.0027 ) , but girls did not show a significant difference ( P = 0.863 ) . Boys four years old or more in Group 1 had a course of frequent relapsing less often than those in Group 2 ( 2 of 13 vs. 6 of 8 , P = 0.0075 ) . CONCLUSION These findings indicate that efficient prednisolone doses may vary between sexes and ages , and that a higher initial prednisolone therapy may be of greater benefit to older boys A series of 89 adult-onset nephrotic patients with minimal changes on renal biopsy was analyzed to compare the rate of response to corticosteroids and cytotoxic agents and the stability of remission or frequency of relapses at different ages . Severe hypertension and diminished renal function were more common in patients aged over 60 years , who formed 22.5 % of the group . Seventy-five patients were given a first course of prednisolone in an initial dose of 60 mg/24 hr . After an eight week course of tapering doses of corticosteroids , only 45 of the 75 patients were in complete remission , 55 patients after 16 weeks and eventually 58 lost their proteinuria . The respective estimates of remission were 60 % , 76 % and 81 % . Subsequently , of the 58 treated patients who responded , 24 % never relapsed . Fifty-six percent of the patients relapsed on a single occasion or infrequently , and only 21 % were frequent relapsers .  Cyclophosphamide was used in 36 patients , in two as initial treatment , in 11 because of corticosteroid resistance , and in the remainder because of relapses . The time-course of loss of proteinuria was similar to that following treatment with corticosteroids , 25 ( 69 % ) losing proteinuria within 16 weeks . Only four patients failed to lose their nephrotic syndrome . Two of them had presented in acute renal failure and all four were over 60 years of age . The stability of remission after cyclophosphamide was better than that reported for children , only 13 of 36 showing relapses and 66 % being in remission at five years , after which no further relapses were seen . ( ABSTRACT TRUNCATED AT 250 WORDS BACKGROUND Long-course prednisolone regimens have been shown to be more effective than short-course regimens in sustaining remission of nephrotic syndrome in children . However , the most beneficial approach among the long-course regimens remains unknown . METHODS Seventy-three children with new-onset nephrotic syndrome were allocated at r and om to the two long-course regimens and followed up for 2 years . Group A was administered prednisolone at a daily dose of 60 mg/m2 for 6 weeks , followed by an alternate-day dose of 40 mg/m2 for 6 weeks ( the long daily regimen ) . Group B was administered the same daily dose for 4 weeks , followed by an alternate-day dose of 60 mg/m2 for 4 weeks , and doses were tapered by 10 mg/m2 every 4 weeks ( the long alternate-day regimen ) . RESULTS Group B had a lower incidence of corticosteroid toxicities than group A during the initial treatment . Kaplan-Meier analysis of the sustained remission rate of the two treatment groups showed a marginally significant difference ( P = 0.069 ) and showed a significant difference when patients were stratified for age of disease onset ( P = 0.048 ) . In a subgroup of younger children ( < 4 years at onset ) , group B had a greater rate of sustained remission ( P < 0.01 ) and fewer children with frequent relapses ( P < 0.05 ) than group A , whereas in older children ( > or = 4 years at onset ) , both groups had similar good sustained remission rates . CONCLUSION These findings collectively indicate that the long alternate-day regimen may be more beneficial , with less corticosteroid toxicities , than the long daily regimen , and children with younger age at disease onset may be susceptible to relapse and especially benefit from the long alternate-day regimen for sustaining remission of the disease Forty-six children with steroid-responsive nephrotic syndrome were r and omly allocated to receive two different prednisolone regimens for initial therapy . Twenty-nine children ( group 1 ) received an intermittent regimen ( 60 mg/m2/day for 4 weeks , followed by 40/mg/m2/day on 3 days a week for 4 weeks ) ; 17 children ( group 2 ) had a long-term regimen ( 60 mg/m2/day for 4 weeks , followed by the same dose on alternate days for 4 weeks and the doses tapered by 10 mg/m2 , given on alternate days every 4 weeks for 5 months ) . There was no difference between the two groups in the regimen used to treat relapses , steroid responsiveness , number of patients with relapses , and frequency of toxic reactions to steroids . However , the number of patients with a relapse within 6 months after initial therapy and the number of those with frequent relapses or steroid dependence were significantly higher in group 1 than in group 2 ( 
    Output:
    
RESULTS In children with a first episode of SSNS , corticosteroids administered for 3 months or more compared with 2 months ' administration are associated with a significant reduction in the risk of relapse at 6 , 12 and 24 months , and in frequent relapsing rates , even though complications did not seem significantly increased ( psychological , ocular , gastrointestinal disorders , hypertension , growth delay , Cushingoid syndrome , infection and osteoporosis ) ( evidence from SR ) .
6-month compared to 3-month treatment regimens are associated with a significant reduction in the risk of relapse at 12 - 24 months ( evidence from SR ) .
Increasing steroids cumulative doses are associated with increasing improvements in the risk of relapse ( evidence from RCT ) .
The risk of relapse at 12 - 24 months correlates inversely with duration of treatment ( evidence from SR ) .