The use of steroid-sparing agents in steroid-sensitive nephrotic syndrome.
Childhood nephrotic syndrome (NS) is frequently characterized by a relapsing course. There is no uniform agreement about the precise stage at which a steroid-sparing agent should be introduced to control the disease. In order to evaluate the treatment strategies and outcome of steroid-sensitive NS over the last 2 decades, a retrospective notes review was undertaken in a cohort of children treated at Great Ormond Street Children's Hospital between 1980 and 2000. From a population of 863 children with NS referred, 509 had frequently relapsing or steroid-dependent disease and 261 children received at least one steroid-sparing agent. Cyclophosphamide was the first choice in 178 patients and in 114 no further steroid-sparing agent was needed. Levamisole was prescribed as the first steroid-sparing agent for 65 children and disease control was achieved in 30%. Cyclosporin A was prescribed in 61 children and sustained remission was induced in 69%. It is concluded that cyclophosphamide is a potent agent in inducing sustained remission in steroid-sensitive NS. Levamisole and cyclosporin A have emerged as attractive steroid-sparing agents. Complications and major side effects of treatment are infrequent but occasionally fatal.
Abeyagunawardena
Asiri S
AS
Nephro-Urology Unit, Institute of Child Health, 30 Guilford Street, London WC1 N 1EH, UK.
Dillon
Michael J
MJ
Rees
Lesley
L
van't Hoff
William
W
Trompeter
Richard S
RS
D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D005938:Glucocorticoids / Q000008:administration & dosage* / Q000009:adverse effects*; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D007223:Infant; D009404:Nephrotic Syndrome / Q000188:drug therapy* / Q000473:pathology; D011239:Prednisolone / Q000008:administration & dosage* / Q000009:adverse effects*; D012008:Recurrence; D012074:Remission Induction; D012189:Retrospective Studies; D016896:Treatment Outcome
D005938:Glucocorticoids; D007166:Immunosuppressive Agents; D011239:Prednisolone