Efficacy of steroids, Cyclosporin and cyclophos-phamide in steroid resistant idiopathic nephrotic syndrome

ABSTRACT

To determine the efficacy of three different treatment protocols in steroid resistant idiopathic nephrotic syndrome, [SRINS]. Interventional study. Department of Nephrology at The Children's Hospital, Lahore, over a period of 3 years from January 2000 to December 2002. Nephrotic children who did not respond to four weeks of steroid therapy [60mg/M2] followed by three pulses of methyl prednisolone [1Gm/1.73M2] over a period of one week were labeled as steroid resistant. Those with histopathological lesions of minimal change disease [MCD], focal segmental glomerulosclerosis [FSGS] and Mes. PGN were divided into 3 groups. Group-I was treated with cyclophosphamide [CPM] and oral steroids, group-II with cyclosporine and oral steroids and group-III with pulse methyl prednisolone [MPP] and oral steroid + CPM. The response to treatment and course of disease were observed in each group. Twenty patients with mean age of 4.4 years were enrolled. On the whole 10 [50%] had complete remission. In group-I, 5 [50%], in group-II, 3 [75%] and in group-III, 2 [33.3%] had complete remission. Depending upon histological lesion 100% [n=2] with MCD, 50% [n=6] with Mes. PGN and 25% [n=1] with FSGS achieved complete remission. Cyclosporine and CPM induced remission in 100% of patients with MCD, while in Mes.PGN response rate in group-I, II, and III was 100% [n=1], 50% [n=1], and 44.4% [n=4] respectively. In patients with FSGS, MPP was the only drug used with limited response of 25% [n=1]. Cyclosporine proved to be a better option for MCD and Mes. PGN, while MPP showed limited response in patients with FSGS