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Treatment of membranous nephropathy in children

Sudesh P Makker1

  • 1Department of Pediatrics, University of California School of Medicine, Davis, USA.

Seminars in Nephrology
|August 19, 2003
PubMed

Insights

Membranous nephropathy (MN) is rare in children. Treatment recommendations for pediatric nephrotic syndrome (NS) rely on adult data, suggesting ACE inhibitors/ARBs and potentially corticosteroids, cyclosporine, or chlorambucil.

Area of Science:

  • Pediatric Nephrology
  • Glomerular Diseases

Background:

  • Membranous nephropathy (MN) is an uncommon pediatric glomerular disease.
  • It is not a frequent cause of idiopathic nephrotic syndrome (NS) in children.
  • Limited uncontrolled data exist for pediatric MN treatment, with no controlled trials.

Purpose of the Study:

  • To review current treatment recommendations for pediatric membranous nephropathy.
  • To outline treatment protocols based on adult data and limited pediatric evidence.

Main Methods:

  • Review of existing uncontrolled pediatric data.
  • Adaptation of treatment guidelines from adult membranous nephropathy studies.
  • Description of treatment protocols for corticosteroids, cyclosporine, and chlorambucil.

Main Results:

  • Older uncontrolled data suggest a significant risk of chronic renal failure in children with NS.
  • Current recommendations for children are extrapolated from adult controlled trials.
  • Angiotensin-converting enzyme (ACE) inhibitors or angiotensin-receptor blockers (ARBs) are recommended for all children.

Conclusions:

  • Pediatric MN treatment relies heavily on adult data due to rarity.
  • Corticosteroids are a potential initial treatment for children with NS.
  • Cyclosporine or chlorambucil may be considered for refractory cases.

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