Intravenous methylprednisolone and oral alkylating agent therapy of prednisone-resistant pediatric focal segmental glomerulosclerosis: a long-term follow-up.
Prednisone-resistant nephrotic syndrome (NS) due to focal segmental glomerulosclerosis (FSGS), the most common acquired disease requiring chronic dialysis and transplantation in children, has a low likelihood of response to alkylating agent therapy. This report summarizes the results of a 0.75-12.5 (average 6.33) year follow-up of 32 pediatric cases of prednisone-resistant FSGS treated with a regimen of high-dose intravenous methylprednisolone (M-P) and alternate-day prednisone, plus an alkylating agent in 25/32. On last followup: 21/32 were in remission [urine protein-to-creatinine ratios (Pru/Cru) < or = 0.2]; 3/32 had mild proteinuria (Pru/Cru > 0.2-0.5); 2/32 had moderate proteinuria (Pru/Cru > 0.5-1.9); and 6/32 remained nephrotic (Pru/Cru > or = 2.0). Of the incomplete or nonresponders; 3/11 progressed to end-stage renal failure; 5/11 had decreased creatinine clearances (CrCl): and 3/11 had persistent proteinuria with normal CrCl. All of the persistently nephrotic children, but none of the complete responders, developed decreased CrCl. All of the complete responders were able to stop treatment; four relapsed but responded well to retreatment.


CONCLUSIONS
This regimen of methylprednisolone and alternate-day prednisone, with or without an alkylating agent, is effective in achieving sustained remissions and preserving normal renal function in the great majority of children with FSGS and prednisone-resistant NS.
Tune
B M
BM
Department of Pediatrics, Stanford University School of Medicine, California 94305-5119, USA.
Kirpekar
R
R
Sibley
R K
RK
Reznik
V M
VM
Griswold
W R
WR
Mendoza
S A
SA
D002675:Child, Preschool; D002699:Chlorambucil / Q000008:administration & dosage*; D003520:Cyclophosphamide / Q000008:administration & dosage*; D004334:Drug Administration Schedule; D004351:Drug Resistance; D004359:Drug Therapy, Combination; D005260:Female; D005500:Follow-Up Studies; D005923:Glomerulosclerosis, Focal Segmental / Q000188:drug therapy* / Q000208:ethnology; D006801:Humans; D008297:Male; D008775:Methylprednisolone / Q000008:administration & dosage*; D009404:Nephrotic Syndrome / Q000188:drug therapy / Q000209:etiology; D011241:Prednisone / Q000008:administration & dosage*; D013997:Time Factors; D016896:Treatment Outcome
D002699:Chlorambucil; D003520:Cyclophosphamide; D011241:Prednisone; D008775:Methylprednisolone