Methylprednisolone pulse therapy in management of non responder nephrotic syndrome

ABSTRACT

Some patients with the diagnosis of childhood nephrotic syndrome are unresponsive to conventional treatment regimens. Recent studies of more aggressive therapies have provided strong evidence of the benefit of high dose methylprednisolone [MP] protocol with alternate day prcdnisone alone or with alternate - day prcdnisone plus an alkylating agent [I] in these patients. From May 1996 to May 1997 we have treated 14 patients with non-responder nephrotic syndrome with methylprednisolone protocol. Eight patients had histologic diagnosis of focal segmental glomerulosclerosis, 3 diffuse mesangial proliferation and 3 has minimal change disease. Cylosporin was added in two patients to methylprednisolone at the beginning of the second course of therapy. The patients were observed for an average of 8 months [range 4-12 months]. In the last follow up there were no patients in remission and all remained nephrotic. Seven patients had persistent massive proteinuria with normal creatinine clearance [CrCl] Two had decreased CrCl. Five progressed to end-stage renal disease. These observations suggest that "Pulse" methylprednisolone is not effective in patients with non responder nephrotic syndrome