Gonadal changes in nephrological patients treated with cyclophosphamide

Therapeutic use of immunosupressive drugs in progressive renal diseases has increased during the last decade. Information concerned severe gonadal damage after such therapy, stresses the need for careful evaluation in each particular case before deciding to use these drugs. Gonadal lesions were investigated in 18 patients who were treated with cyclophosphamide and in one who received chlorambucil at variable doses and length of time; there were frequent relapses in patients with idiopathic nephrotic syndrome and with progressive forms of glomerulonephritis. Nine patients were females and received cyclophosphamide therapy at the ages of 11 a 16 years, being evaluated from 11 to 22 years of age with vaginal smears, gonadotropins and 17-ketosteroids. No alterations were found in these parameters and two of the girls became pregnant and had successful deliveries of healthy babies. Ten patients were males; one of them received chlorambucil and all the others received cyclophosphamide at the ages of 8 to 15 years; they were evaluated from 9 to 19 years of age. Because of their ages, gonadal function was not studied in 3 children, but the other 7 showed azoospermia, testicular atrophy was present in four out of these patients in whom testicular biopsy was performed. The patient who received chlorambucil was among this group. From these results and from the literature, we conclude: 1) immunosuppressive therapy is less risky in girls than in boys; 2) it is imperative to evaluate the risk/benefit ratio before deciding this therapy in any case and 3) doses not above 2 mg/kg/day and for periods no longer than 6 weeks may be considered safe.