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Pulse cyclophosphamide therapy in steroid resistant nephrotic syndrome associated with mesangial proliferative

Abdullah A Al Salloum1

  • 1Associate Professor &Consultant Pediatric Nephrologist, King Khalid University Hospital &King Saud University, Riyadh, Saudi Arabia.

Saudi Journal of Kidney Diseases and Transplantation : an Official Publication of the Saudi Center for Organ Transplantation, Saudi Arabia
|July 24, 2007
PubMed

Insights

Intravenous pulse cyclophosphamide (IVCP) effectively treats steroid-resistant mesangial proliferative glomerulonephritis (MesGN) in children. Most patients responded well, achieving steroid responsiveness and remission with minimal side effects.

Area of Science:

  • Pediatric Nephrology
  • Immunosuppressive Therapy

Background:

  • Mesangial proliferative glomerulonephritis (MesGN) frequently presents as steroid-resistant in pediatric patients.
  • Limited effective treatment options exist for steroid-resistant MesGN, necessitating alternative therapeutic strategies.

Purpose of the Study:

  • To evaluate the efficacy and safety of intravenous pulse cyclophosphamide (IVCP) combined with oral prednisone in children with steroid-resistant MesGN.
  • To assess long-term outcomes, including steroid responsiveness, remission rates, and relapse incidence.

Main Methods:

  • Ten children diagnosed with steroid-resistant MesGN received monthly IVCP (500 mg/m² for six months) concurrently with oral prednisone.
  • Prednisone dosage was initiated at 60 mg/m²/day for four weeks, followed by 40 mg/m²/alternate day for four weeks, then tapered over eight weeks.
  • Patients were followed for four years post-treatment to monitor proteinuria, steroid dependence, and side effects.

Main Results:

  • All ten patients achieved steroid responsiveness following IVCP therapy.
  • Seven patients demonstrated an early response, with no proteinuria after the second IVCP dose.
  • At four years, six patients achieved complete remission and were off steroids; four remained steroid-dependent. No significant adverse events were reported.

Conclusions:

  • Intravenous pulse cyclophosphamide (IVCP) is a safe and effective treatment for pediatric steroid-resistant MesGN.
  • IVCP can induce steroid responsiveness and achieve remission in a significant proportion of children with this condition.
  • Further research is warranted to optimize treatment protocols and long-term management strategies.

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