Comparison of oral and intravenous cyclophosphamide in children with steroid-resistant nephrotic syndrome

Abstract

Background There are variations in remission rates following treatment of steroid-resistant nephrotic syndrome (SRNS) with cyclophosphamide.Objective To compare the efficacy of oral versus intravenous cyclophosphamide (CPA) in the management of pediatric SRNS.Methods This was a prospective study of 41 children with SRNS treated with CPA. One group received oral CPA at a dose of 2 mg/kg body weight/day for 8-12 weeks, while the other group received intravenous CPA at a dose of 500mg/m2 body surface area (BSA) monthly for 6 months. All patients were concomitantly treated with prednisone on alternate days. The primary outcome was the number of patients attaining remission.Results The study was comprised of 20 children receiving oral CPA and 21 children receiving intravenous CPA. There were 29 boys and 12 girls. The mean age of children at the onset of nephrotic syndrome (NS) was 47 ± 40 months old (range 12 months – 13 years), and the mean duration of NS before initiation of CPA therapy was 15 ± 28 months (range 1 – 129 months). Remission was achieved in 29 (70.7%) patients, with no difference between oral and intravenous route of CPA administration. The mean time to achieve remission was 22.7 weeks (about 5 months). The oral route group required less time in achieving remission than the intravenous route group. No association was found between remission and other factors, such as onset of steroid resistance, route of CPA, hypertension and hematuria. Side-effects included infection, anemia, nausea/vomiting, and alopecia. None of the patients required discontinuation of the medication.Conclusion Oral CPA was as effective as intravenous CPA for children with steroid-resistant nephrotic syndrome. [Paediatr Indones. 2011;51:266-71].

Clinical Profile of Pediatric Patients with Steroid-resistant Nephrotic Syndrome Treated by Cyclophosphamide, Cyclosporin A, Mycophenolate Mofetile and Tacrolimus in Hasan Sadikin General Hospital

“…This finding was similar enough with Hidayati et al that found average (SD) of ureum is 28.4 (21.5). 12 The highest creatinine levels in this study were 0.3-1.0 mg / dL, (71.7%), and had an average (SD) of 0.71 (1.02). For creatinine, Hidayati et al listed average and SD of 0.7 (0.7).…”

“…For creatinine, Hidayati et al listed average and SD of 0.7 (0.7). 12 Whereas in the study of Narayan et al, the average creatinine was 0.92(0.25). 15 In children, the ratio of urine protein and creatinine or the ratio of albumin and creatinine to urine when it becomes very useful for diagnose and to rate the function of kidney because it is difficult to collect urine for 24 hours.…”

“…The age group was most in the 2-6 years age group (48.8%). 12 But in the study of Subandiyah et al found that 68.7% of SRNS patients age group was >6 years. 13 The average height in this study is at 115.27 (24.45) cm with a range of 52-167.…”

“…13 For average (SD) in Hidayati et al Studies found in the range 110.1 (50.3). 12 Research results can differ according to different regional demographic factors 17 This variable is needed in examinations to assess kidney function caused by SRNS or by the effects of treatment, to see the patient's tendency in subsequent prognosis, whether it will lead to ESRD or experience improvement. 6,19 In this study, it was found that most subjects experienced remission for less than 6 months (51.5%), experienced remission both <6 months and ≥6 months (61.6%) and used immunosuppressant CPA (87.9%).…”

“…Data from research at Cipto Mangunkusumo Hospital (RSCM), the Department of Child Health Sciences (IKA) in 2003-2010 states that the clinical profile of SRNS patients who tend to remission with CPA treatment are patients with a range of 1-6 years of age, have a type of secondary SRNS, Intravenous (IV) treatment route, and those with no history of hematuria. 12 Currently, the study report on the clinical profiles of pediatric SRNS patients, particularly in Dr. Hasan Sadikin Bandung who received various types of therapy for SRNS is still limited. Then, the data entry of SRNS patient entries in the last 3 years (2017-2019) is more complete than in previous years, so the results of research on SRNS patient profiles are expected to be better.…”