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Induction of Nephrotic Syndrome in Mice by Retrobulbar Injection of Doxorubicin and Prevention of Volume Retention by Sustained Release Aprotinin
Published on: May 6, 2018
Management of the difficult nephrotic patient
1Department of Pediatrics, University of California, School of Medicine, San Diego, USA.
Pediatric Clinics of North America
|December 1, 1995
Summary
Most children with nephrotic syndrome experience relapses and remissions. Steroid-resistant cases, often focal segmental glomerulosclerosis, may benefit from cyclosporine or specific treatment protocols to improve outcomes and prevent kidney failure.
Area of Science:
- Pediatric Nephrology
- Glomerular Diseases
Background:
- Nephrotic syndrome is common in children, often managed with steroids.
- Some children develop steroid resistance and toxicity, necessitating alternative treatments.
- Focal segmental glomerulosclerosis (FSGS) is a frequent biopsy finding in steroid-resistant nephrotic syndrome.
Purpose of the Study:
- To review management strategies for children with nephrotic syndrome.
- To identify effective treatments for steroid-resistant nephrotic syndrome, particularly FSGS.
- To explore options for patients with significant steroid toxicity.
Main Methods:
- Review of clinical management protocols for nephrotic syndrome.
- Analysis of treatment outcomes for steroid-resistant cases.
- Evaluation of therapeutic agents including alkylating agents, cyclosporine, and pulse methylprednisolone.
Main Results:
- Many children with nephrotic syndrome achieve remission with standard steroid therapy.
- Steroid-resistant nephrotic syndrome, often linked to FSGS, poses a challenge.
- Alternative treatments like oral alkylating agents or cyclosporine can manage some steroid-dependent cases.
- Pulse intravenous methylprednisolone and oral alkylating agents may improve outcomes in steroid-resistant FSGS.
Conclusions:
- While most children with nephrotic syndrome respond to steroids, a subset requires alternative therapies.
- Cyclosporine and specific combination therapies show promise for managing steroid-resistant nephrotic syndrome and FSGS.
- Effective management of steroid resistance is crucial to prevent progression to chronic kidney disease.
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