Minimal 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 inferred from the steroid response. It is paradoxical that the major role of immunosuppressive agents in the treatment of the nephrotic syndrome of childhood is in that group with the least convincing evidence of immunopathogenesis-namely, the steroid responders and the patients with minimal change nephrotic syndrome resistant to steroids. Alkylating agents were first used in 1952, and the first report of the use of cyclophosphamide in children occurred more than 20 years ago.'