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Steroid resistant nephrotic syndrome is sustained remission attainable

B R Nammalwar1, M Vijaykumar, N Prahlad

  • 1Division of Nephrology, Kanchi Kamakoti CHILDS Trust Hospital, 12A, Nageswar Road, Nungambakkam, Chennai 600 034, Tamilnadu, India. drmvk@vsnl.net

Indian Pediatrics
|February 9, 2006
PubMed

Insights

Immunosuppressive therapy shows promise for steroid-resistant nephrotic syndrome in children. This treatment effectively induced remission in minimal change disease and diffuse mesangial proliferation but was less effective for focal segmental glomerulosclerosis.

Area of Science:

  • Pediatric Nephrology
  • Immunosuppressive Therapy
  • Glomerular Diseases

Background:

  • Steroid-resistant nephrotic syndrome (SRNS) presents a significant therapeutic challenge in pediatric nephrology.
  • Identifying effective immunosuppressive regimens for SRNS is crucial for improving patient outcomes.

Purpose of the Study:

  • To evaluate the efficacy of a specific immunosuppressive protocol in children diagnosed with steroid-resistant nephrotic syndrome.
  • To assess the long-term remission rates across different histopathological subtypes of SRNS.

Main Methods:

  • A prospective study involving 34 children with SRNS.
  • Treatment consisted of intravenous methylprednisolone, oral prednisolone for one year, and six monthly pulses of intravenous cyclophosphamide.
  • Disease remission was monitored at one, two, and three years post-treatment.

Main Results:

  • The protocol achieved remission in 81.8% of children with minimal change nephrotic syndrome (MCNS) at three years.
  • Remission rates were 66.7% for diffuse mesangial proliferation (DMP) and only 16.7% for focal segmental glomerulosclerosis (FSGS).
  • The therapy demonstrated significant benefit in MCNS and DMP subtypes.

Conclusions:

  • Intravenous methylprednisolone, oral prednisolone, and cyclophosphamide pulse therapy is beneficial for pediatric SRNS with MCNS and DMP.
  • This immunosuppressive regimen is not effective for children with focal segmental glomerulosclerosis.
  • Further research may be needed to explore alternative treatments for SRNS in FSGS cases.

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