Immunosupressive therapy in children with steroid-resistant nephrotic syndrome: single center experience

Echeverri, Catalina Vélez; Valencia, Gustavo Adolfo Zuluaga; Higuita, Lina María Serna; Gayubo, Ana Katherina Serrano; Ochoa, Carolina Lucia; Rosas, Luisa Fernanda Rojas; Muñoz, Laura Carolina; Sierra, Javier; Zuleta, Jhon Jairo; Ruiz, Juan José Vanegas

doi:10.5935/0101-2800.20130032

Cited by 5 publications

(6 citation statements)

References 26 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The present study reported an 80% remission rate for MMF combined with CsA and low-dose prednisone in 10 cases of SRNS, in whom CsA proved failure after three months. Similarly, a 70% remission rate was reported recently by Echeversi and colleagues ( 24 ). MMF is not recommended for sole use in steroid-resistant cases; it was reported to induce the reduction of proteinuria with partial remission ( 21 ).…”

Section: Discussionsupporting

confidence: 81%

“…More recent studies have reported positive results with decrease in relapse rate, less proteinuria, and steroid-sparing dose without any nephrotoxic effect. It was approved by FDA in 1995 for use in pediatric renal transplantation, SRNS, and SDNS ( 24 , 26 ). CPO was used more commonly in the SRNS group (68.6%), mainly as a first-line treatment.…”

Section: Discussionmentioning

confidence: 99%

“…In fact, most controlled studies of children with FRNS or SDNS showed that azathioprine does not reduce the number of children who relapse before 6 months significantly compared to steroids or placebo control groups ( 38 ). MMF use in idiopathic SDNS is still questionable, but it was recommended by Echeverri et al as it reduced the frequency of relapses with reduction of steroid doses without deterioration of the glomerular filtration rate ( 24 ). However, in the present study, only two cases received MMF because of the limited experience with the use of this drug in children.…”

Section: Discussionmentioning

confidence: 99%

See 2 more Smart Citations

Immunosuppressive therapy in children with steroid-resistant, frequently-relapsing, and steroid-dependent idiopathic nephrotic syndrome: a single center experience

Moustafa¹,

Tolba²

2016

Electron physician

View full text Add to dashboard Cite

IntroductionImmunosuppressive agents are recommended for the management of children with steroid-resistant (SRNS), frequently-relapsing (FRNS), and steroid-dependent idiopathic nephrotic syndrome (SDNS). This study evaluated the efficacy of immunosuppressive agents in these cases.MethodsThis is a retrospective analysis of the records of 130 pediatric cases recruited from a tertiary-care center over a period of two years. They were divided into two groups: 51 patients with SRNS (Group I) and 79 cases with SDNS and FRNS (Group II). They were treated with immunosuppressive agents in addition to steroids, either as double- or triple-combination therapy. Complete or partial remission was considered a good response.ResultsIn group I, the proportions of good response to cyclophosphamide, cyclosporine A, and mycophenolate mofetil were 48.6, 60, and 80%, respectively (p = 0.162). In group II, the resistance rate was significantly higher with levamisole than with cyclophosphamide and azathioprine (p = 0.046). Leukopenia was reported infrequently after the administration of cyclophosphamide or azathioprine. The most serious adverse reaction was to cyclosporine A, which induced nephrotoxicity (6.4%), while no adverse effects related to levamisole were reported. Histopathological diagnoses were available in only 39 patients.ConclusionThe high potency of cyclosporine with steroids recommends its use in patients with idiopathic SRNS with a normal glomerular filtration rate. Its efficacy is augmented when combined with mycophenolate mofetil. Cyclophosphamide, orally or as intravenous boluses, together with alternate-day steroids, could be a good option outside the peripubertal age. The outcomes of FRNS and SDNS could be improved by encouraging compliance with the use of levamisole.

show abstract

Section: Discussionsupporting

confidence: 81%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Immunosuppressive therapy in children with steroid-resistant, frequently-relapsing, and steroid-dependent idiopathic nephrotic syndrome: a single center experience

Moustafa¹,

Tolba²

2016

Electron physician

View full text Add to dashboard Cite

show abstract

“…Age at first attack in this study ranged from 3 to 11 years with median of 9 years and mean of 5.30 ± 2.45. On the contrary, Echeverri et al, [20] reported a lower age at first attack which ranged from 7 months to 16 years, with median of 25 months. This difference between studies may be due to different ethnic group.…”

Section: Resultsmentioning

confidence: 92%

Vitamin D level in nephrotic syndrome, Factors of impact?

Marzouk

Ghobrial

Khorshied

et al. 2019

GEGET

View full text Add to dashboard Cite

Introduction Nephrotic syndrome (NS) usually responds to steroid therapy; however, the majority of children relapse, resulting in prolonged and repeated courses of steroid therapy. Vitamin D is a vital component of bone metabolism and calcium homeostasis. Maintenance of adequate levels of vitamin D is recommended to maintain good bone health and other organ systems of NS patients. The study aimed to assess serum 25 (OH) D levels in children with NS, compare its level with healthy age and sex-matched controls and compare its level in different types of NS. Patients and Methods It was a cross-sectional study for measuring 25(OH) D levels in 60 patients with NS and 60 apparently healthy children, to be compared as controls. Nephrotic patients were classified as steroid sensitive (20 cases) steroid dependent (20cases), and steroid resistant (20 cases). Serum 25-hydroxyvitamin [25(OH) D] was measured using Enzyme Linked Immune Sorbent Assay (ELISA) technique. Results Serum 25(OH) D was significantly lower in NS patients than control group (p<0.001).Steroid resistant nephrotic syndrome (SRNS) patient group showed the highest drop than the other 2 groups (p<0.001). There was significant negative correlation between vitamin D level and number of relapses, 24 hours urinary proteins and serum cholesterol. Conclusion It is recommended that NS patients especially on long term steroid therapy should undergo regular follow up of vitamin D level and early prophylactic supplementation with calcium and vitamin D should be advised.

show abstract

“…MMF is reported to induce the reduction of proteinuria with partial remission (23). However, some studies have reported positive results with decrease in relapse rate, less proteinuria, and steroid sparing dose without any nephrotoxic effect (24,25). Due to lack of side effects such as liver and kidney toxicity and myelosuppression, MMF has become a commonly used immunosuppressant, but the study results are variable with regard to its efficacy in SRNS children (16).…”

Section: Discussionmentioning

confidence: 99%

Immunosuppressive Therapy in Children With Steroid-Resistant Nephrotic Syndrome

et al. 2018

Iran J Pediatr

View full text Add to dashboard Cite

Background: Treatment of steroid-resistant nephrotic syndrome (SRNS) remains a huge challenge in pediatric patients. Immunosuppressive agents including cyclosporine A (CsA), tacrolimus (TAC) and mycophenolate mofetil (MMF) are recommended for the management of children with SRNS. The aim of this study was to compare the efficacy of CsA, TAC and MMF in children with SRNS and provide guidance for clinical practice. Methods: This is a retrospective analysis of the records of 70 children with SRNS recruited from a children hospital over a period of seven years. They were treated with CsA, TAC and MMF as initial immunosuppressive therapy in addition to steroids. Complete or partial remission was considered a good response. Results: Five (41.7%) of 12 children who were on CsA therapy achieved remission at 6 months and 5 (41.7%) at 12 months. Nine (19.1%) of 47 patients treated with TAC achieved remission at 6 months, 20 (42.6%) at 12 months and 6 (12.8%) within or over 24 months. The remission achieved at 6 months and 12 months was 4 (36.4%) and 2 (18.2%) respectively in MMF group. The relapse rates in children who had achieved remission were 30.0%, 45.7% and 50.0% in CsA, TAC and MMF group respectively. Conclusions: Based on similar baseline characteristics, CsA and TAC as initial therapy for SRNS have a better remission and relapse rates whereas MMF shows a rapid remission effect.

show abstract

Immunosupressive therapy in children with steroid-resistant nephrotic syndrome: single center experience

Cited by 5 publications

References 26 publications

Immunosuppressive therapy in children with steroid-resistant, frequently-relapsing, and steroid-dependent idiopathic nephrotic syndrome: a single center experience

Immunosuppressive therapy in children with steroid-resistant, frequently-relapsing, and steroid-dependent idiopathic nephrotic syndrome: a single center experience

Vitamin D level in nephrotic syndrome, Factors of impact?

Immunosuppressive Therapy in Children With Steroid-Resistant Nephrotic Syndrome

Contact Info

Product

Resources

About