Cyclophosphamide therapy in frequently relapsing nephrotic syndrome with and without steroid dependence

An 8-week therapy with cyclophosphamide (CP) and alternate-day prednisone was given to 65 patients having steroid-sensitive, frequently relapsing nephrotic syndrome, including 17 with steroid dependence. It induced remissions of less than 6 months in 18 patients, 6 to 36 months in 21 and over 3 years in 26. Considering a remission of 6 months as significant, certain clinical variables were compared in patients without such a response with those getting longer remissions. In the group with frequent relapses a higher proportion of patients aged above 8 years had remissions of over 6 months as well as over 3 years, than those who were younger at CP therapy. Among patients with frequent relapses as well as those with steroid dependence, a post-CP remission of more than 6 months was associated with a better long-term course. The response to CP in both groups was similar regarding the duration of remissions, but a greater proportion of steroid-dependent patients subsequently again showed steroid dependence or frequent relapses. Our findings suggest that a higher age at CP therapy and an ensuing remission of over 6 months are predictors of a better response, and steroid dependence of a less favorable outcome.