Use of Combined Hormone and Mechlorethamine (Nitrogen Mustard) Therapy in Lipoid Nephrosis

West, Clark D.

doi:10.1001/archpedi.1958.02060050502007

Cited by 11 publications

(2 citation statements)

References 20 publications

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“…The use of an alkylating agent in steroid-resistant nephrotic syndrome was first initiated with nitrogen mustard as early as 1958 ( 38 ). This was extended to other alkylating agents, cyclophosphamide and chlorambucil, in the 1960s and prompted the ISKDC to conduct a randomized control trial to define the role of cyclophosphamide in children with early non-responders and frequently relapsing nephrotic syndrome.…”

Section: Treatments For Nephrotic Syndromementioning

confidence: 99%

History of Nephrotic Syndrome and Evolution of its Treatment

Pal

Kaskel

2016

Front. Pediatr.

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The recognition, evaluation, and early treatment of nephrotic syndrome in infants and children originate from physicians dating back to Hippocrates. It took nearly another 1000 years before the condition was described for its massive edema requiring treatment with herbs and other remedies. A rich history of observations and interpretations followed over the course of centuries until the recognition of the combination of clinical findings of foamy urine and swelling of the body, and measurements of urinary protein and blood analyses showed the phenotypic characteristics of the syndrome that were eventually linked to the early anatomic descriptions from first kidney autopsies and then renal biopsy analyses. Coincident with these findings were a series of treatment modalities involving the use of natural compounds to a host of immunosuppressive agents that are applied today. With the advent of molecular and precision medicine, the field is poised to make major advances in our understanding and effective treatment of nephrotic syndrome and prevent its long-term sequelae.

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Section: Treatments For Nephrotic Syndromementioning

confidence: 99%

History of Nephrotic Syndrome and Evolution of its Treatment

Pal

Kaskel

2016

Front. Pediatr.

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“…It has been known for many years that alky lating agents such as nitrogen mustard (chlormethine), [35] cyclophosphamide [36.37] and chlorambucil138] are more effective in MCNS than corticosteroids, i.e. can produce longlasting remissions.…”

Section: Alkylating Agentsmentioning

confidence: 99%

Management of Nephrotic Syndrome in Children

Brodehl

1996

Clin. Immunother.

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Cytotoxic Drugs in Steroid-Resistant Renal Disease

Grupe¹

1966

Am J Dis Child

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THE USE of cytotoxic agents in the treatment of renal diseases was first reported in 1949 by Chasis 1,2 using nitrogen mustard (mechlorethamine) in adults with chronic glomerulonephritis. Shortly thereafter, Kel-ley and Panos3 confirmed improvement in children with nephrosis, and Taylor4 in adults with chronic glomerulonephritis, using the same approach. These reports were followed by others,5-9 but as the therapeutic value of steroids became more widely accepted, cytotoxic drugs were displaced as therapeutic agents. Interest was renewed in 1963 by Coldbeck,10 Kellum and Haserick,11 and Goodman and Wolff.12 There has been further encouragement in the use of these agents in the treatment of other nonneoplastic diseases 12-15 as well as in renal diseases.15-22 This report will review 3\m=1/2\years' experience in 25 children with cytotoxic drugs in addition to corticosteroids in the treatment of chronic renal diseases. Patients and MethodsThe agents used in this study were cyclophosphamide (Cytoxan), azathioprine (Imuran), and chlorambucil (Leukeran). A total of 37 courses have been given to 25 children with idiopathic nephrotic syn¬ drome, systemic lupus erythematosus, chronic glo¬ merulonephritis, or anaphylactoid purpura nephritis. The children were 6 to 17y¿ years old at the time of treatment and had had renal disease for three months to 14 years.Corticosteroids were administered to the 16 pa-tients with idiopathic nephrosis * as described ear¬ lier.23 In essence the children received 40 to 60 mg of prednisone (or its equivalent) daily. In the 12 children whose proteinuria persisted, daily steroid was continued for two to six months, as tolerated, when an intermittent maintenance regimen was be¬ gun which consisted of 80 mg of prednisone on three consecutive days of each week. In only two children was continuous steroid therapy given for more than ten months. There were four patients whose proteinuria disappeared on daily therapy. For these, daily corticosteroid was continued until the urine had remained free of protein for two weeks. Then the intermittent regimen described above was instituted for an additional two months of proteinfree urine, followed by a gradual reduction in dosage until discontinued four to six weeks later. Either sulfisoxazole (Gantrisin) or a broad spectrum anti¬ biotic during periods of anasarca was administered daily to all children during the course of steroid therapy. The six patients with lupus erythematosus were treated essentially as described above. For several patients the daily dose of corticosteroid was reduced to a minimum sustaining level for prolonged periods rather than the intermittent therapy. Only two chil¬ dren received continuous steroid therapy for more than ten months. The cytotoxic agents were administered according to the following criteria. (1) Nephrotic syndrome, where treatment with steroids might have been ef¬ fective but where problems with hypercorticism en¬ dangered the patient, or where steroids in high doses were required for six months or longer in ord...

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Use of Combined Hormone and Mechlorethamine (Nitrogen Mustard) Therapy in Lipoid Nephrosis

Cited by 11 publications

References 20 publications

History of Nephrotic Syndrome and Evolution of its Treatment

History of Nephrotic Syndrome and Evolution of its Treatment

Management of Nephrotic Syndrome in Children

Cytotoxic Drugs in Steroid-Resistant Renal Disease

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