Early exercise in nephrotic syndrome did not worsen remission in a small trial

Design

Single-centre randomised controlled trial

Population

27 hospitalised adults with nephrotic syndrome on glucocorticoids

Primary outcome

Peak oxygen uptake at 6 weeks

Effect

Difference 2.46 mL/kg/min (−0.12 to 5.03); non-remission RR 0.673 (0.266–1.703)

A single-centre randomised trial in Japan, published in the Journal of Nephrology on 22 October, allocated 27 adults hospitalised with nephrotic syndrome on glucocorticoids to early supervised exercise or standard care for six weeks.

Peak oxygen uptake rose by 3.45 mL/kg/min with exercise and 1.00 with standard care. The adjusted difference of 2.46 was not statistically significant, though the gain within the exercise group was. Non-remission at six weeks was, if anything, lower with exercise (risk ratio 0.67), with no sign of harm.

Many patients with nephrotic syndrome are told to rest, out of concern that activity will worsen proteinuria. This trial is too small to settle that, but it offers no support for the fear, and inactivity on high-dose steroids has its own costs in muscle loss and thrombosis risk.

The practical change is modest: do not routinely restrict activity, and encourage graded exercise as tolerated.

• Consider encouraging graded exercise in adults with nephrotic syndrome rather than prescribing bed rest.
• Start gently and supervise early sessions in hospitalised patients.
• Monitor proteinuria and kidney function as usual; this trial found no worsening.
• Remember that immobility adds to thrombosis risk in nephrotic syndrome.

Why it matters

It challenges the habit of advising rest, which costs fitness and may add thrombotic risk.

Don't overread it

With 27 patients, the trial cannot exclude harm or prove a fitness benefit between groups.

The statistics, in plain English

The between-group difference in peak oxygen uptake was 2.46 mL/kg/min (95% CI −0.12 to 5.03), just crossing zero. The non-remission risk ratio of 0.67 (0.27 to 1.70) is consistent with benefit, no effect or harm, because the trial was small.

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