Controlled Trial of Azathioprine in Children With Nephrotic Syndrome

Abramowicz, Mark; Barnett, Henry L.; Edelmann, Chester M.; Greifer, Ira; Kobayashi, Osamu; Arneil, Gavin C.; Barron, Bruce; Gordillo-P, G.; Hallman, N; Tiddens, Harm

doi:10.1016/s0140-6736(70)91093-7

Cited by 180 publications

(48 citation statements)

References 4 publications

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“…[8] ISKDC reported that MCNS, FSGS, DMP and other types of glomerulonephritis may be seen in 77%, 10%, 3%, and 10% of children with nephrotic syndrome, respectively. [7] In our series, 74%, 13%, and 13% of our patients had MCNS, FSGS, and DMP, respectively.…”

Section: Discussionmentioning

confidence: 99%

Steroid Responsiveness of Children with Idiopathic Nephrotic Syndrome in Southeastern Region of Turkey

et al. 2007

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Background. Our aim was to determine the prognostic factors effective in the response to steroid treatment and relapse frequency. Patients and Methods. In this study, we evaluated 84 children with idiopathic nephrotic syndrome followed-up from 1997-2002. The variables were analyzed with respect to medical history, physical examination, laboratory findings, response to treatment, and factors associated with remissions and relapses. Our study group consisted of 62 children with minimal change nephrotic syndrome (MCNS), 11 children with focal segmental glomerulosclerosis (FSGS), and 11 children with diffuse mesangial proliferation (DMP). Results. According to response to steroids; 57.1% were steroid-sensitive with infrequent relapses, 22.6% were steroid-dependent with frequent relapses, and 20.2% were steroid-non-responders. Significantly high non-responder ratios to steroids were found in children with initial hypertension and hematuria (p < 0.05). Although patients older than six years were found to be associated with steroid nonresponse (p < 0.05), the number of relapses were found to be increased with an increasing number of infections (p < 0.05). The time period for the first relapse was found to be statistically correlated with relapse numbers of the first 6 (p = 0.001) and 12 (p = 0.01) months. Conclusion. The time span between initial presentation and remission and the number of infections were significant for relapse frequency. The existence of hematuria and hypertension and age greater than 6 years at initial presentation were associated with steroid non-responsiveness. The likelihood of developing resistance to the treatment should be emphasized early to the parents of patients bearing these risk factors, and hence the possible disappointment in the family should be prevented.

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Section: Discussionmentioning

confidence: 99%

Steroid Responsiveness of Children with Idiopathic Nephrotic Syndrome in Southeastern Region of Turkey

et al. 2007

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“…All patients with a low C3 complement, postinfectious glomerulonephlitis, systemic diseases such as lupus erythematosus, diabetes mellitus or amyloidosis, vasculitis, or Henoch-Schoenlein nephritis, metabolic or toxic nephritis, and hereditary glomerular disease were excluded. Definitions and criteria for NS, remission and relapses were the same as those used by the ISKDC [1] and our own group [2].…”

Section: Methodsmentioning

confidence: 99%

“…The minimal change nephrotic syndrome (NS) usually responds to corticosteroids and proteinuria disappears in 90% of all steroid responsive cases within 21 days [1,3,5,9]. A standard regimen for the initial attack is now used almost world-wide, consisting of 4 weeks continuous prednisone (60 mg/m 2 per day) and 4 weeks of intermittent prednisone (40 mg/m 2 on 3 out of 7 days) [1] or alternate day prednisone (40 mg/m 2 per 48 h) [2,6].…”

Section: Introductionmentioning

confidence: 99%

“…A standard regimen for the initial attack is now used almost world-wide, consisting of 4 weeks continuous prednisone (60 mg/m 2 per day) and 4 weeks of intermittent prednisone (40 mg/m 2 on 3 out of 7 days) [1] or alternate day prednisone (40 mg/m 2 per 48 h) [2,6]. The International Study of Kidney Disease in Children (ISKDC) showed that 55% of children relapsed after the initial prednisone regimen within 6 months and that 34% of patients had two or more relapses during the first 6 months [10].…”

Section: Introductionmentioning

confidence: 99%

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Long versus standard prednisone therapy for initial treatment of idiopathic nephrotic syndrome in children

1993

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Two regimens of steroid treatment for the initial attack of idiopathic nephrotic syndrome (NS) in children were compared in a controlled prospective multi-centre study. Long prednisone therapy consisted of 60 mg/m2 per 24 h for 6 weeks, followed by alternate day 40 mg/m2 per 48 h for 6 weeks. The standard prednisone therapy was 60 mg/m2 per 24 h for 4 weeks, followed by 40 mg/m2 per 48 h for 4 weeks. A total of 71 children with an initial attack of idiopathic NS were allocated at random to the two groups. The cumulative rate of patients with sustained remissions after 2 years was significantly higher after the long course than after the standard treatment (49% vs 19%, P = 0.0079). The mean relapse rate per patient at intervals of 3, 6 and 12 months was lower in the long-course prednisone group than in the standard prednisone group, and the proportion of children with frequent relapses during any subsequent 6 months period was lower in the long-course group than in the standard group (29% vs 57%, P = 0.03). Mild side-effects of corticosteroid therapy were observed more frequently after long-course prednisone treatment. It is concluded that long-course prednisone therapy of the initial attack of steroid responsive NS is preferable to the standard regimen because it reduces the rate of subsequent relapses without increasing the risk for severe steroidal side-effects.

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“…Alkylating agents such as cyclophos phamide and chlorambucil are more effective than corti costeroids in achieving a long-lasting remission in mini mal change nephrotic syndrome. Additional agents used in patients with frequently relapsing nephrotic syndrome include cyclosporine A; levamisole; dipyridamole and indomethacin, which reduce proteinuria (although their roles in treating nephrotic syndrome remain unclear); and azathioprine (although several studies have shown that it is ineffective) [36]. The discussion to follow will be focused on the following agents: cyclophosphamide; chlorambucil; nitrogen mustard; cyclosporine A; levami sole; anticoagulants; antiplatelet agents (e.g.…”

Section: Noncorticosteroid Treatmentsmentioning

confidence: 99%

Nephrosis in Childhood

Salcedo

Thabet²,

Latta³

et al. 1995

Nephron

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Succinct aspects of clinical features, pathophysiology and prognosis of nephrotic syndrome in childhood, and indications for performing renal biopsy are enumerated in this review. Orthodox treatment of the nephrotic syndrome with more recent therapeutic approaches, and the role of diuretics, albumin infusions and immunizations in patients with the nephrotic syndrome are reviewed. The etiology of peritonitis, acute renal failure, and renal transplantation are re-examined to update nephrologists on the associated complications of this common childhood disease.

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Controlled Trial of Azathioprine in Children With Nephrotic Syndrome

Cited by 180 publications

References 4 publications

Steroid Responsiveness of Children with Idiopathic Nephrotic Syndrome in Southeastern Region of Turkey

Steroid Responsiveness of Children with Idiopathic Nephrotic Syndrome in Southeastern Region of Turkey

Long versus standard prednisone therapy for initial treatment of idiopathic nephrotic syndrome in children

Nephrosis in Childhood

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