Pulse cyclophosphamide inadequately suppresses reoccurrence of minimal change nephrotic syndrome in corticoid-dependent children.
نویسندگان
چکیده
BACKGROUND In minimal change nephrotic syndrome (MNCS), the most common primary nephrotic syndrome in children, approximately 95% of cases show excellent responses to steroid therapy. However, responding patients may become steroid dependent and experience serious side effects. Although oral cyclophosphamide has been recommended in these patients, long-term side effects such as gonadal toxicity are an important concern. Therefore, cyclophosphamide pulses given intravenously may provide an option that maintains remission with less-frequent side effects. METHODS We treated 20 primary steroid-dependent MCNS patients (15 boys and five girls) with intravenous cyclophosphamide. The patients were children with ages ranging from 3 to 15 years of age. Remission was induced by steroids followed by cyclophosphamide at a dose of 500 mg/m2 body surface area per month for 6 months. During this period, we attempted to completely withdraw steroids and maintain patients on cyclophosphamide alone. We monitored the patients for the occurrence of relapse and side effects during this period and for an additional 6 months after withdrawal of cyclophosphamide. RESULTS At the end of the 6-month cyclophosphamide treatment period (i.e. 4 months after steroid discontinuation), nine patients (45%) were in remission on cyclophosphamide alone. However, patients that maintained treatment-free remission (cyclophosphamide responders) decreased to five (25%), two (10%) and one (5%) at 6 months, 1 year and 2 years, respectively. CONCLUSION We found that a 6-month course of pulse cyclophosphamide produced unfavourable effects in the majority of paediatric patients with steroid-dependent nephrotic syndrome.
منابع مشابه
Steroid resistant nephrotic syndrome is sustained remission attainable.
A prospective study was undertaken to find out the benefit of immunosuppressive therapy(IV methyl prednisolone followed by oral prednisolone therapy for one year along with six doses of pulse monthly IV cyclophosphamide) in children with steroid resistant nephrotic syndrome. Thirty-four children with steroid resistant nephrotic syndrome were treated with above regime. The remission of the disea...
متن کاملبررسی سرانجام ده ساله کودکان مبتلا به سندرم نفروتیک حساس به استروئید
Background: Nephrotic syndrome is one of the most remarkable diseases in childhood. The majority of patients have prompt response to corticosteroids. Methods: In this study, we retrospectively evaluate the outcome of patients with steroid-responsive nephritic syndrome. Medical records from January 1996 to September 2006 were reviewed to identify all children with steroid sensitive nephrotic syn...
متن کاملMinimal change nephrotic syndrome and cyclophosphamide
The term 'minimal change nephrotic syndrome' has become synonymous with the expression 'steroid responsive nephrotic syndrome', the latter term having the merit of focusing on the most important objective characteristic of the condition. Nevertheless, it is somewhat illogical to define this condition by a negative histological feature, which in the majority of cases remains a presumption inferr...
متن کاملMinimal change nephrotic syndrome and cyclophosphamide
The term 'minimal change nephrotic syndrome' has become synonymous with the expression 'steroid responsive nephrotic syndrome', the latter term having the merit of focusing on the most important objective characteristic of the condition. Nevertheless, it is somewhat illogical to define this condition by a negative histological feature, which in the majority of cases remains a presumption inferr...
متن کاملMinimal change nephrotic syndrome and cyclophosphamide
The term 'minimal change nephrotic syndrome' has become synonymous with the expression 'steroid responsive nephrotic syndrome', the latter term having the merit of focusing on the most important objective characteristic of the condition. Nevertheless, it is somewhat illogical to define this condition by a negative histological feature, which in the majority of cases remains a presumption inferr...
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عنوان ژورنال:
- Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association
دوره 18 10 شماره
صفحات -
تاریخ انتشار 2003