Pulse cyclophosphamide therapy in steroid resistant nephrotic syndrome associated with mesangial proliferative glomerulonephritis.
High proportion of patients with mesangial proliferative glomerulonephritis (MesGN) is steroid resistant. We report the response of ten children with steroid resistant MesGN treated with intravenous pulse cyclophosphamide (IVCP) together with oral prednisone. All patients were treated with pulse IVCP 500 mg/m 2 per month for six months; oral prednisolone was given concurrently at a dose of 60 mg/m 2 per day for four weeks, then 40 mg/m 2 /per alternate day for another four weeks, which was tapered over the following eight weeks. All the patients were followed up for four years after treatment. All the patients became steroid responsive after the completion of IVCP therapy; nine patients were weaned of steroids and one patient could not. Seven patients showed early response to IVCP; they had no proteinuria after the 2nd dose of IVCP. Three patients had complete remission and never had any relapses over four years of observations. By the end of the observation period, there were six patients who achieved complete remission and they were off steroid, while four patients remained steroid dependent. None of the patients developed any significant side effects. We believe that IVCP is a safe and effective therapeutic modality in children with steroid resistant MesGN.
Al Salloum
Abdullah A
AA
Associate Professor &Consultant Pediatric Nephrologist, King Khalid University Hospital &King Saud University, Riyadh, Saudi Arabia.