[Comparison of cyclophosphamide and cyclosporine in the treatment of steroid-resistant idiopathic nephrotic syndrome in children].

Abstract

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.

CONCLUSION:

For children with MCD, CsA combining prednisolone could result in a higher remission rate than intravenous CTX combining prednisolone.

• Authors: Jia Rao, Hong Xu, Qi Cao, Wen-yan Huang, Li-jun Zhou
• Journal: Zhong nan da xue xue bao. Yi xue ban = Journal of Central South University. Medical sciences (Zhong Nan Da Xue Xue Bao Yi Xue Ban) Vol. 32 Issue 6 Pg. 958-63 (Dec 2007) ISSN: 1672-7347 [Print] China
• PMID: 18182710 (Publication Type: Comparative Study, English Abstract, Journal Article)

Chemical References

• Cyclosporine
• Cyclophosphamide

Topics

• Child
• Child, Preschool
• Cyclophosphamide (therapeutic use)
• Cyclosporine (therapeutic use)
• Female
• Humans
• Infant
• Male
• Nephrotic Syndrome (congenital, drug therapy)
• Retrospective Studies
• Treatment Outcome