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

OBJECTIVE
To determine the efficacy of three different treatment protocols in steroid resistant idiopathic nephrotic syndrome, (SRINS).


DESIGN
Interventional study.


PLACE AND DURATION OF STUDY
Department of Nephrology at The Children's Hospital, Lahore, over a period of 3 years from January 2000 to December 2002.


PATIENTS AND METHODS
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.


RESULTS
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).


CONCLUSION
Cyclosporine proved to be a better option for MCD and Mes.PGN, while MPP showed limited response in patients with FSGS.