Interventions for steroid-resistant nephrotic syndrome: a systematic review

Abstract

In a systematic review and meta-analysis of randomized controlled trials (RCT), we aimed to evaluate the benefits and harms of all interventions for children with steroid-resistant nephrotic syndrome (SRNS). Nine RCTs involving 225 children were included. Cyclosporin when compared with placebo or no treatment significantly increased the number of children who achieved complete remission [3 trials, 49 children, relative risk (RR) for persistent nephrotic syndrome 0.64, 95% confidence intervals (CI), 0.47-0.88]. There was no significant difference in the number of children who achieved complete remission between oral cyclophosphamide with prednisone and prednisone alone [2 trials, 91 children, RR 1.01, 95% CI 0.74-1.36], between intravenous cyclophosphamide and oral cyclophosphamide [1 study, 11 children, RR 0.09, 95% CI 0.01-1.39], and between azathioprine with prednisone and prednisone alone [1 trial, 31 children, RR 1.01, 95% CI 0.77-1.32]. No RCTs were identified comparing combination regimens comprising high-dose steroids, alkylating agents or cyclosporin with single agents, placebo, or no treatment. Further adequately powered and well-designed RCTs are needed to confirm the efficacy of cyclosporin and to evaluate regimens of high-dose steroids with alkylating agents or cyclosporin for SRNS.

The clinical effectiveness and cost-effectiveness of treatments for children with idiopathic steroid-resistant nephrotic syndrome: a systematic review

“…However, few side-effects were reported in the trials and findings reported differed little between the control and treatment groups. As reported in Habashy and colleagues, 42 this may be due to small patient numbers in the trials, short follow-up periods and incomplete reporting. None of the ciclosporin studies reports data on the side-effects that commonly concern patients and clinicians, namely nephrotoxicity and hirsutism.…”

“…In total, 1815 references were identified and, of these, two systematic reviews 40,42 and 11 trials met the inclusion criteria for the review. Six were parallel RCTs, 22,32,[43][44][45][46] three were randomised cross-over trials, 38,41,47 one was a CCT 48 and one was a prospective cohort study with concurrent controls.…”

“…None of the ciclosporin studies reports data on the side-effects that commonly concern patients and clinicians, namely nephrotoxicity and hirsutism. 42 Sideeffects from oral and intravenous steroids include behavioural and psychological changes, gastric irritation, fluid retention, hypertension, steroidinduced bone disease and growth retardation. 23 The risk and consequences of complications in SRNS should be an important factor in any economic analysis.…”

Clinical Profile and Outcome of Steroid Resistant Nephrotic Syndrome in Children: An Eastern Indian Single Centre Study

“…MMF is a promising therapeutic alternative without nephrotoxicity [20]. But there is no single consensus regarding the indications of renal biopsy and treatment protocols in children with SRNS [13,14,15,16]. Optimal combinations of these agents with the least toxicity remain to be determined [12].…”

Outcome Sindrom Nefrotik Pada Anak €“ Penelitian Prospektif Studi Cohort

“…Beberapa faktor yang mempermudah anak SN mengalami infeksi kuman adalah rendahnya kadar IgG karena sintesis yang tidak sempurna, lepasnya faktor B dalam urin, dan tidak sempurnanya fungsi limfosit T. Faktor B adalah cofactor dari C3b dalam jalur alternatif dari komplemen, yang berperan penting dalam opsonisasi kuman (23). Disamping itu pengobatan kortikosteroid atau imunosupresif menambah risiko infeksi (24,25).…”