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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
Summary
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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