CYCLOSPORINE USE IN IDIOPATHIC NEPHROTIC SYNDROME IN CHILDREN

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CYCLOSPORINE USE IN IDIOPATHIC NEPHROTIC SYNDROME IN CHILDREN

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Co-author 1

Bassam Saeed bmsaeed2000@yahoo.com Farah Association for Child with Kidney Disease Pediatric Nephrology Damascus Syrian Arab Republic *

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Introduction

The treatment of steroid-resistant Focal Segmental Glomerulo-Sclerosis (FSGS) pose one of the most perplexing and frustrating problems for the nephrologist. CsA is widely considered as the treatment of choice for nephrotic children for whom steroid has failed to induce sustained remission.

Methods

The aim of this study was to investigate the clinical outcome in children with idiopathic nephrotic syndrome (INS) under CsA treatment. A total of 22 children presented with either steroid-resistant nephrotic syndrome (SRNS) (14 children), or steroid–dependant nephrotic syndrome (SDNS) (8 children) at a mean age of 7.6 years (range: 23months –15 years).

Results

Renal histology showed FSGS in 14, minimal change disease (MCD) in 4, diffuse mesangial glomerulonephritis (MesGN) in 3, and membranous glomerulonephritis (MGN) in2 patients. Treatment with CsA in combination with alternate-day prednisolone induced remission in 15 patients; 9 of them had complete remission and 6 patients had partial remission. 7 Patients were resistant to CsA therapy. only 2 of the 14 patients with SRNS had a complete remission and 5 patients were partially responders, so the overall remission rate of SRNS after CsA treatment was 50 % ( 7 /14 ). The remaining 7 patients with SRNS were resistant to CsA therapy. 7 of 8 children with SDNS had a complete remission while only one patient had partially responded to CsA therapy; interestingly none of the SDNS cases was resistant to CsA therapy.

Conclusion

: this study has demonstrated that CsA is more effective in inducing remission in SDNS than in SRNS, however the overall remission rate of 50% in SRNS is good enough to encourage us to believe that CsA is probably the best option for those children.

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