Historical Treatment of Childhood Kidney Disease in the 1960s
Prednisone (or prednisolone) was the drug routinely given daily to children in the 1960s for childhood kidney disease, particularly idiopathic nephrotic syndrome. This corticosteroid became the mainstay of treatment starting in the 1950s and revolutionized the management of nephrotic syndrome by dramatically reducing mortality from approximately 50% to around 3%. 1, 2
Historical Context and Treatment Evolution
Corticosteroids were introduced in the 1950s and quickly became standard therapy for childhood nephrotic syndrome, with oral prednisone or prednisolone administered daily as the primary treatment throughout the 1960s. 1, 3
The mortality rate dropped dramatically from frequent deaths due to infections in untreated children to approximately 3% after corticosteroid therapy became standard, with infection remaining the most important cause of death even with treatment. 1
Treatment protocols in the 1960s were developed in an ad hoc manner, without the rigorous evidence base that guides modern therapy; the optimal doses and durations were not systematically clarified until decades later through randomized controlled trials. 1
Standard Treatment Regimen
The typical daily dosing used prednisone at 60 mg/m²/day or 2 mg/kg/day (maximum 60 mg/day) as a single morning dose, which became the established standard that persists in modern guidelines. 4, 5, 6
Most children (approximately 85%) responded to corticosteroids by achieving remission within 4 weeks of daily oral prednisone administration, establishing this as steroid-sensitive nephrotic syndrome. 7
However, approximately 70% of children experienced relapses with recurrent episodes of edema and proteinuria, requiring repeated courses of corticosteroid therapy and exposing them to cumulative toxicity. 1
Important Clinical Caveat
The major trade-off of corticosteroid therapy was the known adverse effects including obesity, poor growth, hypertension, diabetes mellitus, osteoporosis, and adrenal suppression—side effects that were accepted given the life-saving benefits in an era with limited alternative therapies. 1
Steroid-sparing agents such as cyclophosphamide, chlorambucil, and later cyclosporine were not widely available or studied until the 1970s-1990s, making daily prednisone the only viable option for most children with nephrotic syndrome during the 1960s. 2, 8