[Comparison of cyclophosphamide and cyclosporine in the treatment of steroid-resistant idiopathic nephrotic syndrome in children].
OBJECTIVE
To compare the therapeutic outcome of cyclophosphamide(CTX) and cyclosporine A (CsA) in the treatment of steroid-resistant idiopathic nephrotic syndrome (SRNS) in children.


METHODS
Thirty-seven children with SRNS were analysed in a retrospective study from Jan 2001 to Dec. 2006. There was initial renal histology of minimal change (MCD) in 28 children, focal segmental glomerulosclerosis (FSGS) in 7 and mesangial proliferative glomerulonephritis (MsPGN) in the other 2. These patients were divided into 2 groups: one group received the induction therapy consisting of intravenous CTX and prednisolone, and the another group were treated with CsA [initial dose 3-5mg/(kg d)] and prednisolone.


RESULTS
(1) Thirty children received CTX, while 21 received CsA, and the total efficacy was 40.0% and 85.7% respectively after the 12 month follow-up. Children with MCD receiving CsA had a better response than those treated with CTX (93.8% vs 36.3%, P<0.05). Children with FSGS receiving CsA did not show a significant difference compared with those treated with CTX (75.0% vs 50.0%, P>0.05). (2) There were no significant associations between age, pathology, clinic type and therapeutic outcome in the 2 groups(P>0.05). (3)The rate of liver functional impairment, leukocytopenia, vomiting and nausea was 10%, 16.7% and 33.3%, respectively in children receiving CTX. The rate of hypertrichosis, gingival hyperplasia and hypertension was 71.4%, 23.8% and 9.5% respectively in children receiving CsA. Two children had central adverse effect. Two patients with FSGS progressed into end-stage renal failure.


CONCLUSIONS
For children with MCD, CsA combining prednisolone could result in a higher remission rate than intravenous CTX combining prednisolone.
Rao
Jia
J
Department of Pediatric Nephrology and Urology, Children's Hospital, Fudan University, Shanghai 200032, China.
Xu
Hong
H
Cao
Qi
Q
Huang
Wen-yan
WY
Zhou
Li-jun
LJ
D002648:Child; D002675:Child, Preschool; D003520:Cyclophosphamide / Q000627:therapeutic use*; D016572:Cyclosporine / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D009404:Nephrotic Syndrome / Q000151:congenital* / Q000188:drug therapy; D012189:Retrospective Studies; D016896:Treatment Outcome
D016572:Cyclosporine; D003520:Cyclophosphamide