Minimal-lesion nephrotic syndrome with early resistance to steroid therapy

The initial and long-term clinical course of six children with steroid-resistant, minimal-lesion nephrotic syndrome was evaluated. All children experienced remission after two to five weeks of combined cyclophosphamide-prednisone therapy. Following cyclophosphamide treatment, three patients have relapsed and have become steroid sensitive. The clinical outcome was quite favorable. These data suggest: (1) cyclophosphamide may induce a prompt remission in patients with minimal glomerular lesions who have early resistance to corticosteroids; (2) relapses which occur after cyclophosphamide should be treated with prednisone alone, even though the patient was previously steroid resistant; (3) the ultimate outcome is related more to the nature of the histopathologic lesion than to a lack of steroid responsiveness.