Introduction Childhood nephrotic syndrome follows a relapsing and remitting course. Corticosteroids are the mainstay of treatment and can be administered as a single early morning dose or as split doses. Usually, in the treatment of relapses, corticosteroids are administered daily until remission is achieved, followed by alternate day therapy. Early attainment of remission results in reduced morbidity and a reduced steroid burden.

Objectives To compare the time duration to attain remission using a single dose versus a split dose regime of prednisolone in the treatment of relapses of childhood nephrotic syndrome.

Methods Children between 1 and 14 years of age admitted to a tertiary care paediatric nephrology unit from August 2019 to February 2020 with a relapse of nephrotic syndrome were randomised to two groups. Patients in Group A received oral prednisolone at 60 mg/m² as a single morning dose while those in Group B received the same total dose as two divided doses(2/3 mane; 1/3 vesper). The treatment regime was continued until remission was achieved following which all patients were switched to alternate day prednisolone at 60 mg/m² which was given as a single morning dose. The time duration from the commencement of prednisolone to the attainment of remission for the two groups was compared.

Results 104 children were included, of which 49(age 2.16–13.8 years) received prednisolone as a split dose while 55(age 1.83–13.67 years) received a single morning dose. The mean duration to achieve remission was 5.04 days(SD 1.59;SE 0.22) for the split dose group and 6.74 days(SD 3.72;SE 0.50) for the single dose group. This difference was statistically highly significant. [t(102)=2.967;p=0.001(<0.05)]. There was no difference in the side effect profile.

Conclusions Use of prednisolone as a split dose results in earlier remission when compared to a single morning dose in the treatment of relapses of childhood nephrotic syndrome.