Steroids and immunosuppressants

Steroids are immunosuppressants that are made naturally in the body. Steroids can also be made as medicines, which can reduce inflammation in the kidney. They may be used in acute kidney injury (AKI) that is caused by nephrotic syndrome or vasculitis.

A common steroid used is prednisolone. If your child needs to take a steroid, your doctor will work out the amount (the dose) that is right for them. They may need to take a large dose each day to start with, and then the dose slowly reduced. Your doctor will usually monitor blood and urine tests to help decide when to change doses.

Other immunosuppressants also suppress the immune system, but they are not produced by the body. These medicines may be used with steroids. A common immunosuppressant is cyclophosphamide. Other immunosuppressants are azathioprine, ciclosporin, mycophenolate mofetil (MMF) and tacrolimus.


Children taking some immunosuppressants are not able to have live vaccines (immunisations).

These vaccines include: MMR (for measles, mumps and rubella), varicella (for chicken pox) and BCG (for tuberculosis).

Speak with your child’s doctor to check which vaccines your child can have.


Children taking these medicines are more likely to get infections. Speak with your child’s doctor or nurse, and your child’s teacher or daycare manager, about how you can help prevent infection. Contact your doctor straight away if your child:

  • has been in contact with someone who has chicken pox (if they have not had this illness before) or measles (if they have not had the MMR vaccine, which protects against measles, mumps and rubella); or
  • is unwell and you are worried about an infection

If your child does get an infection, he or she may need to take an antibiotic medicine, which kills the germs that cause infection. Your child must take the medicine for the number of days that the doctor has told you, or until all of the medicine has been taken.

Steroids: side-effects you need to do something about

We use medicines to help children get better, but sometimes they have effects we do not want – side-effects.

Contact your doctor straight away if your child has any of the following while on steroid medicines:

  • fever (temperature above 38°C), with a sore throat or a cough
  • a rash or severe bruising
  • bad stomach pain or repeated vomiting – sometimes steroids can cause ulcers in the stomach

Other side-effects that affect some children are below – speak with your doctor or nurse if you are concerned or need more support:

  • nausea, vomiting, stomach pain and/or indigestion (heartburn) due to irritation to the lining of the stomach – your doctor may give your child some medicine to treat this
  • behavioural problems – you may find that your child is more likely to have tantrums, be moody, feel depressed, have difficulty sleeping or have nightmares
  • weight gain and larger appetite – you can help by making sure your child has lots of physical activity and eats fruits, vegetables and low-calorie food, rather than food that is high in calories (such as cakes, biscuits, sweets and crisps), and by reducing the portion size
  • high blood pressure (hypertension) – your child’s blood pressure will be regularly checked, and if it is too high, will need to be controlled by eating a no-added salt diet or taking medicines

There may, sometimes, be other side-effects that are not listed above. If you notice anything unusual and are concerned, contact your doctor.

Other medicines 

If your child has serious side-effects from the medicines, they may be prescribed other drugs. For example, if they feel sick (nausea) or vomit, your doctor may prescribe medicines that help him or her feel better. 

Side-effects with high doses or long courses

When steroids are needed over a long time, or in high doses, they may have other side-effects.

  • Steroids can slow growth and affect puberty. They can also cause growth of body hair and irregular periods in girls. Your doctor will check your child’s growth and development. If you have any concerns, talk to your doctor.
  • All steroid medicines, including prednisolone, may affect the adrenal glands so that they produce less of a hormone called cortisol when the body is stressed (e.g. during illness or injury). This means that your child may have more difficulty fighting off an infection, or may recover less quickly from injury of after surgery.
  • Your child’s skin may become thinner, and heal more slowly than usual. Acne (spots) may become worse or your child may develop mouth ulcers or thrush (candidiasis). If you are concerned, contact your doctor.
  • Your child may develop problems with his or her hip bones, or their bones may become weaker (osteoporosis). The muscles around his or her hips and shoulders may also become weaker. If your child has any difficulty walking or moving around, contact your doctor.
  • Occasionally, steroids cause diabetes. If your child seems more thirsty than normal, needs to pass urine (wee) often, or starts wetting the bed at night, contact your doctor.

More information

  • Acute kidney injury

    Acute kidney injury (AKI) is when the kidneys stop working over a short period of time (a few days or a few weeks).

  • Nephrotic syndrome

    Nephrotic syndrome happens in children whose kidneys leak too much protein into their urine, and causes swelling in the body.

  • Advice on measles for children with kidney disease

    Children with kidney disease who are taking immunosuppressant medication can be more severely affected if they catch measles. Contact your child’s kidney unit if your child has been in contact with someone who has or goes on to develop measles.