Non-corticosteroid treatment for nephrotic syndrome in children

Durkan, Anne M.; Hodson, Elisabeth M; Willis, Narelle S; Craig, Jonathan C.

doi:10.1002/14651858.cd002290.pub3

Cited by 87 publications

(94 citation statements)

References 62 publications

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“…In particular, the association between young age and recurrent SSNS has previously been reported by [3,5,[7][8][9]. In our study, the two youngest ages (from 1.5 to <3 and from three to <6 years) were stably significant relapse prognostic variables in both Cox and multinomial regression models.…”

Section: Discussionsupporting

confidence: 76%

“…Childhood nephrotic syndrome (NS) is often steroid sensitive (SS), usually with favorable long-term prognosis characterized however by a relapsing course in 50-80% of cases [1][2][3][4][5]. The relapsing patients come to be re-treated with prednisolone (PRED) which results in a high incidence of adverse effects (AE).…”

Section: Introductionmentioning

confidence: 99%

“…Various treatment options include alternative agents for steroid-sparing effects such as alkylating agents, antimetabolites or calcineurin inhibitors. However, it is difficult to predict the non-relapsing course of SSNS, and remission rates after three years was have been reported as being between 24% and 45% [3][4][5].…”

Section: Introductionmentioning

confidence: 99%

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Clinical Course of Steroid Sensitive Nephrotic Syndrome in Children: Outcome and Outlook

Fomina¹

2011

TOPEDJ

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Abstract:Introduction: The aim of our study was to investigate the relative efficiency and adverse effects of various treatments of steroid sensitive nephrotic syndrome (SSNS) in children, and to determine factors associated with relapse risk in these patients. Materials and Method:We retrospectively studied the data from 690 SSNS children treated in referral center over 25 years. The analyzed treatment protocols were: Prednisolone (PRED, eight weeks in a dose 1.5-2.0 mg/kg, then it tapering and given for 9-12 months), Chlorambucil (CHL, cumulative dose 28.5-30 mg/kg), Cyclophosphamide intravenously (CYC I.V., cumulative dose of 30-36 mg/kg, then supporting dose of CHL, cumulative dose of 20-25 mg/kg) and intramuscular (CYC I.M., cumulative dose of 120-150 mg/kg). The alkylating agents were used after remission induction by PRED and under its protection.Results: Cumulative relapse-free survival was 81.9%, 69.0% and 64.5% after 12, 36 and 60 months, respectively. In multivariate analyses, relapse risk was associated with age of treatment (<6 years), and both PRED and CYC I.V. The only predictive factor for early relapse was PRED, unlike two and more relapses group where PRED and CYC I.V. as well as age from 3 to 6 years was highly prognostic. The high probability of sustained remission in combination with relatively mild adverse effects was observed for PRED used at first episode and CHL used at relapse. Conclusion:To summarize, our protocols characterized by the prolonged PRED and CHL demonstrated promising results and should be considered as an efficient alternative strategy in SSNS management.

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Section: Discussionsupporting

confidence: 76%

Section: Introductionmentioning

confidence: 99%

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Clinical Course of Steroid Sensitive Nephrotic Syndrome in Children: Outcome and Outlook

Fomina¹

2011

TOPEDJ

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“…Most of the patients achieved partial or complete remission within one year of follow up. Immunosuppressive agents are used to prolong periods of remission in children; however these agents have significant potential adverse effects [6]. However, in our study there were no major side effects.…”

Section: Discussioncontrasting

confidence: 47%

“…A number of medications such as Methyl prednisolone, Cyclophosphamide, Vincristine, Mycophenolate Moefetil (MMF) and CyA have been used with varying results. Recent reports have showed remission rates ranging from 20% to 70% using these drugs in SRNS [5,6,7]. Moreover, there are some reports supporting the idea that MCD, Diffuse Mesangial Proliferation (DMP), and FSGS are separate diseases because of different response rate to corticosteroid and the histological findings offer data of prognostic significance [8].…”

Section: Introductionmentioning

confidence: 99%