title: Management of the difficult nephrotic patient.
abstract: Most children with nephrotic syndrome do well, usually with multiple relapses and remissions. Some children require high doses of oral steroids to sustain a remission and develop significant steroid toxicity. These patients frequently can be managed with oral alkylating agents or with cyclosporine. A few nephrotic children to not respond to oral prednisone. The most common biopsy finding in steroid-resistant patients is focal segmental glomerulosclerosis. Many patients with this condition progress to chronic renal failure. Evidence suggests that the outcome is improved with either cyclosporine or with a protocol using pulse intravenous methylprednisolone and oral alkylating agents.
authors.affiliation: Department of Pediatrics, University of California, School of Medicine, San Diego, USA.
authors.forename: S A
authors.initials: SA
authors.lastname: Mendoza
authors.forename: B M
authors.initials: BM
authors.lastname: Tune
mesh_terms: D002648:Child; D005260:Female; D006801:Humans; D009404:Nephrotic Syndrome / Q000188:drug therapy*; D013256:Steroids / Q000627:therapeutic use
chemical_list: D013256:Steroids