Long-term therapy with cyclosporine and alternate-day prednisone in patients with idiopathic Steroid Resistant Nephrotic Syndrome (SRNS)
Keywords:
Idiopathic nephrotic syndrome, Steroid resistant, Cyclosporine therapy
Abstract
Introduction: The treatment of SRNS, which comprises 10-20% patients with idiopathic nephrotic syndrome, is difficult. Currently calcineurin inhibitors are recommended as the 1st line drug in idiopathic SRNS.
Objective: Studies on cyclosporine are available for SRNS as early as 1980. We report here our long-term experience with Cyclosporine & prednisolone in these patients during those days of early experiences on cyclosporine.
Methods: Case records of patients with idiopathic SRNS between 1995 & 2006 were reviewed. Patients who received >6-months treatment with cyclosporine & prednisolone were included. Those with onset in infancy & Schwartz GFR <60 ml/min/1.73m2 were excluded. Response was defined as complete remission, partial remission or non-response.
Results: Of 58 patients, 32 had initial and 26 had late resistance. All received therapy with PO steroids. Some received PO/IV cyclophosphamide. The mean (SD) age at presentation & treatment were 60.4 (38) & 75 (43) months. All except one had pretreatment biopsy. Biopsy showed minimal change disease, focal segmented glomerulosclerosis and mesangioproliferative glomerulonephritis in 20, 25 and 12 cases respectively. The mean time to onset of complete remission or partial remission was 3.3 (2.7) months & duration of treatment was 22.4 (14.7) months. Complete remission, partial response, no response & late cyclosporine resistance were seen in 48%, 33%, 12% & 7% patients respectively. Responses were similar in patients with various histologic lesions. Of 18 patients re-biopsied after 2 years of therapy, 3 (16.7%) showed evidence of cyclosporine toxicity, which were mild and manageable.
Conclusion: Treatment with cyclosporine and alternate day prednisolone is effective and safe in patients with idiopathic SRNS.
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References
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4 . P Niaudet. Treatment of idiopathic nephritic syndrome in children Up To Date www.uptodate.com
5. Tarshish P, Tobin JN, Bernstein J, Edelmann CM J. Prognostic significance of the early course of minimal change nephritic syndrome : report of the International Study of Kidney Disease in Children. J Am Soc Nephrol 1997;8:769-776
6. Ponticelli C, Rizzoni G, Edefonti A, et al. A randomized trial of cyclosporine in steroid-resistant idiopathic nephrotic syndrome. Kidney Int. 1993 Jun;43(6):1377-84.[pubmed]
7. Arbeitsgemeinschaft fur Padiatrische Nephrology. Short versus standard prednisone therapy for initial treatment of idiopathic nephrotic syndrome in children. Lancet 1988;1;380.[pubmed]
8. Hodsone E, Knight J, Willis N, Craig J. Corticosteroid therapy for nephritic syndrome in children Cochrane database syst rev 2004; 2:CD001533.
9. Brodehl J. The treatment of minimal change nephrotic syndrome: lessons learned from multicentre co-operative studies. Eur J Pediatr. 1991 Apr;150(6):380-7.[pubmed]
10. Hiraoka M, Tsukahara H, Matsubara K, et al. A randomized study of two long-course prednisolone regimens for nephrotic syndrome in children. Am J Kidney Dis. 2003 Jun;41(6):1155-62.[pubmed]
11. Kim JS, Bellew CA, Silverstein DM, et al. High incidence of initial and late steroid resistance in childhood nephrotic syndrome. Kidney Int. 2005 Sep;68(3):1275-81. DOI:10.1111/j.1523-1755.2005.00524.x
12. Ehrich JH, Geerlings C, Zivicnjak M, et al. Steroid-resistant idiopathic childhood nephrosis: over diagnosed and undertreated. Nephrol Dial Transplant. 2007 Aug;22(8):2183-93. Epub 2007 May 15. DOI:10.1093/ndt/gfm092
13. Cattran DC, Rao P. Long-term outcome in children and adults with classic focal segmental glomerulosclerosis. Am J Kidney Dis. 1998 Jul;32(1):72-9.[pubmed]
14. Mendoza SA, Reznik VM, Griswold WR, et al. Treatment of steroid-resistant focal segmental glomerulosclerosis with pulse methylprednisolone and alkylating agents. Pediatr Nephrol. 1990 Jul;4(4):303-7.[pubmed]
15. Tsugawa K, Tanaka H, Nakahata T, Ito E (2004) Effective therapy of a child case of refractory nephrotic syndrome with tacrolimus. Tohoku J Exp Med 204:237-241.
16. Nammalwar BR, Vijaykumar M, Prahlad N, Jain DV. Steroid resistant nephrotic syndrome is sustained remission attainable. Indian Pediatr. 2006 Jan;43(1):39-43.[pubmed]
17. International Study in Kidney Disease in Children. The primary nephrotic syndrome in children. Identification of patients with minimal change nephrotic syndrome from initial response to prednisolone. A report of ISKDC. J Pediatr 1981;98:561-564.[pubmed]
18. Abrantes MM, Cardosa LSB, Lima EM, Silva JMP, Diniz JS, Bambirra EA, Oliveira EA. Clinical course of 110 children and adolescents with primary focal segmental glomerulosclerosis. Pediatr Nephrol 2006;21:482-489.
19. Pankaj Hari. R.N. Srivastava Pulse corticosteroid therapy with methylprednisolone or dexamethasone Indan J Pediatr 1998;65: 557-560.
20. Murnaghan K, Vasmant D, Bensman A. Pulse methylprednisolone in severe idiopathic childhood nephritic syndrome Acta Pediatric Scand 1984; 73:733.
21. Borges FF, Shiraichi L, da Silva MP, et al. Is focal segmental glomerulosclerosis increasing in patients with nephrotic syndrome? Pediatr Nephrol. 2007 Sep;22(9):1309-13. Epub 2007 Jun 6. DOI:10.1007/s00467-007-0516-0.[pubmed]
22. Schwaderer P, Knuppel T, Konrad M, Mehls O, Scharer K, Schaefer F, Weber S. Clinical course and NPHS2 analysis in patients with late steroid resistant nephotic syndrome Pediatr Nephrol 2008;23:251-256
23. Niaudet P. Treatment of childhood steroid resistant idiopathic nephrosis with a combination of cyclosporine and prednisone. French Society of Pediatric Nephrology. J Pediatr 1994;125: 981-986
24. Pena A, Bravo J, Melgosa M. Fernandez C, Merceguer C, Espinosa L, Alonso A, Picazo ML, Navarro M. Steroid resistant nephritic syndrome: long term evaluation after sequential therapy. Pediatr Nephrol 2007;22: 1875-1880
25. Ruf RG, Lichtenberger A, Karle SM, Hass JP, Anaclato FE, Schultheiss M, Zalewiski, I, Imm A, Ruf EM, Mucha B, Bagga A, Neuhas T, Fuchshuber A, BakkalogluA, Hildebrandt F. Patients with mutations in NPSH2(podocin) do not respond to standard steroid treatment of nephritic syndrome. J Am Soc Nephrol 2004;15::722-732
26. Weber S, Gribouval O, Esquivel EL, et al. NPHS2 mutation analysis shows genetic heterogeneity of steroid-resistant nephrotic syndrome and low post-transplant recurrence. Kidney Int. 2004 Aug;66(2):571-9. DOI:10.1111/j.1523-1755.2004.00776.x.[pubmed]
27. Berdeli A, Mir S, Yavascan O, Serdaroglu E, Bak M, Aksu N, Oner A, Anarat A, Donmez O, Yildiz N, Sever l, Table Y, Dusunselr, Sonmez F, Cakar N. NPHS2(podocin)mutations in Tarkish children with idiopathic nephritic syndrome. Pediatr Nephrol 2007;22:2031-2040
28. Niaudet P. Podocin and nephrotic syndrome: implications for the clinician. J Am Soc Nephrol. 2004 Mar;15(3):832-4.[pubmed]
29. Ruf RG, Schultheiss M, Lichtenberger A, et al. Prevalence of WT1 mutations in a large cohort of patients with steroid-resistant and steroid-sensitive nephrotic syndrome. Kidney Int. 2004 Aug;66(2):564-70. DOI:10.1111/j.1523-1755.2004.00775.x.[pubmed]
30. Gil Chernin.Saskia F. Heeringa.Rashid Gbadegesin. Jinhong Liu. Bernward G. Hinkes. Chritopher N. Vlangos. Virginia Vega – Warner. Friedhelm Hildebrandt Low prevalence of NPHS2 mutations in African American children with steroid- resistant nephritic syndrome Pediatr Nephrol (2008) 23:1455-1460
31. Martinelli R, Pereira LJ, Silva OM, et al. Cyclophosphamide in the treatment of focal segmental glomerulosclerosis. Braz J Med Biol Res. 2004 Sep;37(9):1365-72. Epub 2004 Aug 24. DOI:/S0100-879X2004000900010.[pubmed]
32. Elhence R, Gulati S, Kher V, et al. Intravenous pulse cyclophosphamide--a new regime for steroid-resistant minimal change nephrotic syndrome. Pediatr Nephrol. 1994 Feb;8(1):1-3.[pubmed]
33. Trompeter Rs SRNS, a review of of the treatment of FSGS in children In: recent advances in ped nephrology , Murakami K, Kitagawa T, Yabuta K, Sakai T(Eds) Experta Medica , Amsterdam, 1987,pp 363-371
34. Tune BM, Kirpekar R, Sibley RK, et al. Intravenous methylprednisolone and oral alkylating agent therapy of prednisone-resistant pediatric focal segmental glomerulosclerosis: a long-term follow-up. Clin Nephrol. 1995 Feb;43(2):84-8.[pubmed]
35. Guillot AP, Kim MS Pulse steroid therapy does not alter the course of focal segmental glomerulosclerosis J Am Soc Nephrol 1993; 4:276]
36. Bagga A, Mudigoudar BD, Hari P, Vasudev V. Enalapril dosage in steroid-resistant nephrotic syndrome. Pediatr Nephrol. 2004 Jan;19(1):45-50. Epub 2003 Nov 25. DOI:10.1007/s00467-003-1314-y
37. Yi Z, Li Z, Wu XC, HeQN, Dang XQ, He XJ. Effect of fosinopril in children with steroid resistant idiopathic nephrotic syndrome Pediatr Nephrol 2006;21:967-972
38. Hodson EM, Habashy D,Craig JC Interventions for idiopathic steroid resistant nephritic syndrome in children(Cochrane review) From the Cochrane Library, Issue 3, 2006.
39. Zietse R, Derkx FH, Schalekamp MA, Weimar W. Cyclosporin and the glomerular filtration barrier in minimal change disease and membranous glomerulopathy. Contrib Nephrol. 1995;114:6-18.[pubmed]
40. Borel JF, Feurer C, Gubler HU, Stähelin H. Biological effects of cyclosporin A: a new antilymphocytic agent. 1976. Agents Actions. 1994 Dec;43(3-4):179-86.[pubmed]
41. E. R. Maher, P. Sweny, M. Chappel, Z. Varghese and J.F. Moorhead Cyclosporin in the treatment of steroid responsive and steroid resistant Nephrotic syndrome in adults Nephrol Dial Transplant 1988; 3: 728-732
42. Hymes LC. Steroid-resistant, cyclosporine-responsive, relapsing nephrotic syndrome. Pediatr Nephrol. 1995 Apr;9(2):137-9.[pubmed]
43. Hafeez F, Ahmad TM, Anwar S. Efficacy of steroids, cyclosporin and cyclophos-phamide in steroid resistant idiopathic nephrotic syndrome. J Coll Physicians Surg Pak. 2005 Jun;15(6):329-32. DOI:06.2005/JCPSP.329332.[pubmed]
44. Tejani A Suthanthiran M, Pomrantz A. A randomized controlled trial of low dose prednisone and ciclosporin versus high dose prednesone in nephritic syndrome of children. Nephron 1991;59:96-99
45. Niaudet P.Treatment of childhood steroid resistant idiopathic nephrosis with a combination of cyclosporine and prednisone. French Society of Pediatric Nephrology. J Pediatr 1994;125: 981-986
46. Gregory MJ, Smoyer WE, Sedmanet Long term cyclosporine therapy for pediatric nephritic syndrome . : A clinical and histologic analysis. J Am Soc Nephrol 1996; 7:543,
47. Ponticelli C, Edefonti A, Ghio L, et al. Cyclosporin versus cyclophosphamide for patients with steroid-dependent and frequently relapsing idiopathic nephrotic syndrome: a multicentre randomized controlled trial. Nephrol Dial Transplant. 1993;8(12):1326-32.[pubmed]
48. Ingulli E, Singh A, Baqi N, et al. Aggressive, long-term cyclosporine therapy for steroid-resistant focal segmental glomerulosclerosis. J Am Soc Nephrol. 1995 Apr;5(10):1820-5.[pubmed]
49. Plank C, Kalb V, Hinkes B, Hildebrandt F, Gefeller O, Rascher W; Arbeitsgemschaft fur Padiatrische Nephrology. Cyclosporine A is superior to cyclophosphamide in children with steroid resistant nephrotic syndrome- a randomized controlled multicenter trial by the Arbeitsgemschaft fur Padiatrische Nephrology. Pediatr Nephrol 2008;DOI 10.1007/s00467-008-0794-1
50. Ponticelli C, Rizzoni G, Edefonti A, et al. A randomized trial of cyclosporine in steroid-resistant idiopathic nephrotic syndrome. Kidney Int. 1993 Jun;43(6):1377-84. [pubmed]
51. Lieberman KV , Tezani A. A randomized double blind placebo controlled trial on cyclosporine in SR FSGS in children J Am Soc Nephrol 1996;7; 56-63.[pubmed]
52. Valerie Leroy. Veronique Baudouin. Corinne Alberti. Genevieve Guest.Patrick Niaudet. Chantal Loirat. Georges Deschenes. Paul Czernichow. Dominique Simon Growth in boys with idiopathic nephritic syndrome on long- term cyclosporine and steroid treatment Pediatr Nephrol(2009) 24:2393-2400
53. Cattran DC, Rao P. Long term outcome in children and adults with classic focal segmental glomerulosclerosis. Am J Kidney Disease 1988;32: 72-79.[pubmed]
54. Adhikari M, Coovadia HM Cyclosporin in SRNS S Afr Med J 1994 Nov;(11);783-6
55. J Li, Q Li, J Lu and Z Li : Immunosuppression therapy in children with steroid resistant nephrotic syndrome. Iran J Pediatr. 2018;28(1): e11567. Doi 10,5812/ijp. 11567
2. Wong W. Idiopathic nephrotic syndrome in New Zealand children, demographic clinical features, initial management and outcome after twelve months follow up: results of a three year national surveillance study. J Paediatric Child Health 2007;43:337-341
3. Sharples PM, Poulton J, White RH. Steroid responsive nephrotic syndrome is more common in Asians. Arch Dis Child. 1985 Nov;60(11):1014-7.[pubmed]
4 . P Niaudet. Treatment of idiopathic nephritic syndrome in children Up To Date www.uptodate.com
5. Tarshish P, Tobin JN, Bernstein J, Edelmann CM J. Prognostic significance of the early course of minimal change nephritic syndrome : report of the International Study of Kidney Disease in Children. J Am Soc Nephrol 1997;8:769-776
6. Ponticelli C, Rizzoni G, Edefonti A, et al. A randomized trial of cyclosporine in steroid-resistant idiopathic nephrotic syndrome. Kidney Int. 1993 Jun;43(6):1377-84.[pubmed]
7. Arbeitsgemeinschaft fur Padiatrische Nephrology. Short versus standard prednisone therapy for initial treatment of idiopathic nephrotic syndrome in children. Lancet 1988;1;380.[pubmed]
8. Hodsone E, Knight J, Willis N, Craig J. Corticosteroid therapy for nephritic syndrome in children Cochrane database syst rev 2004; 2:CD001533.
9. Brodehl J. The treatment of minimal change nephrotic syndrome: lessons learned from multicentre co-operative studies. Eur J Pediatr. 1991 Apr;150(6):380-7.[pubmed]
10. Hiraoka M, Tsukahara H, Matsubara K, et al. A randomized study of two long-course prednisolone regimens for nephrotic syndrome in children. Am J Kidney Dis. 2003 Jun;41(6):1155-62.[pubmed]
11. Kim JS, Bellew CA, Silverstein DM, et al. High incidence of initial and late steroid resistance in childhood nephrotic syndrome. Kidney Int. 2005 Sep;68(3):1275-81. DOI:10.1111/j.1523-1755.2005.00524.x
12. Ehrich JH, Geerlings C, Zivicnjak M, et al. Steroid-resistant idiopathic childhood nephrosis: over diagnosed and undertreated. Nephrol Dial Transplant. 2007 Aug;22(8):2183-93. Epub 2007 May 15. DOI:10.1093/ndt/gfm092
13. Cattran DC, Rao P. Long-term outcome in children and adults with classic focal segmental glomerulosclerosis. Am J Kidney Dis. 1998 Jul;32(1):72-9.[pubmed]
14. Mendoza SA, Reznik VM, Griswold WR, et al. Treatment of steroid-resistant focal segmental glomerulosclerosis with pulse methylprednisolone and alkylating agents. Pediatr Nephrol. 1990 Jul;4(4):303-7.[pubmed]
15. Tsugawa K, Tanaka H, Nakahata T, Ito E (2004) Effective therapy of a child case of refractory nephrotic syndrome with tacrolimus. Tohoku J Exp Med 204:237-241.
16. Nammalwar BR, Vijaykumar M, Prahlad N, Jain DV. Steroid resistant nephrotic syndrome is sustained remission attainable. Indian Pediatr. 2006 Jan;43(1):39-43.[pubmed]
17. International Study in Kidney Disease in Children. The primary nephrotic syndrome in children. Identification of patients with minimal change nephrotic syndrome from initial response to prednisolone. A report of ISKDC. J Pediatr 1981;98:561-564.[pubmed]
18. Abrantes MM, Cardosa LSB, Lima EM, Silva JMP, Diniz JS, Bambirra EA, Oliveira EA. Clinical course of 110 children and adolescents with primary focal segmental glomerulosclerosis. Pediatr Nephrol 2006;21:482-489.
19. Pankaj Hari. R.N. Srivastava Pulse corticosteroid therapy with methylprednisolone or dexamethasone Indan J Pediatr 1998;65: 557-560.
20. Murnaghan K, Vasmant D, Bensman A. Pulse methylprednisolone in severe idiopathic childhood nephritic syndrome Acta Pediatric Scand 1984; 73:733.
21. Borges FF, Shiraichi L, da Silva MP, et al. Is focal segmental glomerulosclerosis increasing in patients with nephrotic syndrome? Pediatr Nephrol. 2007 Sep;22(9):1309-13. Epub 2007 Jun 6. DOI:10.1007/s00467-007-0516-0.[pubmed]
22. Schwaderer P, Knuppel T, Konrad M, Mehls O, Scharer K, Schaefer F, Weber S. Clinical course and NPHS2 analysis in patients with late steroid resistant nephotic syndrome Pediatr Nephrol 2008;23:251-256
23. Niaudet P. Treatment of childhood steroid resistant idiopathic nephrosis with a combination of cyclosporine and prednisone. French Society of Pediatric Nephrology. J Pediatr 1994;125: 981-986
24. Pena A, Bravo J, Melgosa M. Fernandez C, Merceguer C, Espinosa L, Alonso A, Picazo ML, Navarro M. Steroid resistant nephritic syndrome: long term evaluation after sequential therapy. Pediatr Nephrol 2007;22: 1875-1880
25. Ruf RG, Lichtenberger A, Karle SM, Hass JP, Anaclato FE, Schultheiss M, Zalewiski, I, Imm A, Ruf EM, Mucha B, Bagga A, Neuhas T, Fuchshuber A, BakkalogluA, Hildebrandt F. Patients with mutations in NPSH2(podocin) do not respond to standard steroid treatment of nephritic syndrome. J Am Soc Nephrol 2004;15::722-732
26. Weber S, Gribouval O, Esquivel EL, et al. NPHS2 mutation analysis shows genetic heterogeneity of steroid-resistant nephrotic syndrome and low post-transplant recurrence. Kidney Int. 2004 Aug;66(2):571-9. DOI:10.1111/j.1523-1755.2004.00776.x.[pubmed]
27. Berdeli A, Mir S, Yavascan O, Serdaroglu E, Bak M, Aksu N, Oner A, Anarat A, Donmez O, Yildiz N, Sever l, Table Y, Dusunselr, Sonmez F, Cakar N. NPHS2(podocin)mutations in Tarkish children with idiopathic nephritic syndrome. Pediatr Nephrol 2007;22:2031-2040
28. Niaudet P. Podocin and nephrotic syndrome: implications for the clinician. J Am Soc Nephrol. 2004 Mar;15(3):832-4.[pubmed]
29. Ruf RG, Schultheiss M, Lichtenberger A, et al. Prevalence of WT1 mutations in a large cohort of patients with steroid-resistant and steroid-sensitive nephrotic syndrome. Kidney Int. 2004 Aug;66(2):564-70. DOI:10.1111/j.1523-1755.2004.00775.x.[pubmed]
30. Gil Chernin.Saskia F. Heeringa.Rashid Gbadegesin. Jinhong Liu. Bernward G. Hinkes. Chritopher N. Vlangos. Virginia Vega – Warner. Friedhelm Hildebrandt Low prevalence of NPHS2 mutations in African American children with steroid- resistant nephritic syndrome Pediatr Nephrol (2008) 23:1455-1460
31. Martinelli R, Pereira LJ, Silva OM, et al. Cyclophosphamide in the treatment of focal segmental glomerulosclerosis. Braz J Med Biol Res. 2004 Sep;37(9):1365-72. Epub 2004 Aug 24. DOI:/S0100-879X2004000900010.[pubmed]
32. Elhence R, Gulati S, Kher V, et al. Intravenous pulse cyclophosphamide--a new regime for steroid-resistant minimal change nephrotic syndrome. Pediatr Nephrol. 1994 Feb;8(1):1-3.[pubmed]
33. Trompeter Rs SRNS, a review of of the treatment of FSGS in children In: recent advances in ped nephrology , Murakami K, Kitagawa T, Yabuta K, Sakai T(Eds) Experta Medica , Amsterdam, 1987,pp 363-371
34. Tune BM, Kirpekar R, Sibley RK, et al. Intravenous methylprednisolone and oral alkylating agent therapy of prednisone-resistant pediatric focal segmental glomerulosclerosis: a long-term follow-up. Clin Nephrol. 1995 Feb;43(2):84-8.[pubmed]
35. Guillot AP, Kim MS Pulse steroid therapy does not alter the course of focal segmental glomerulosclerosis J Am Soc Nephrol 1993; 4:276]
36. Bagga A, Mudigoudar BD, Hari P, Vasudev V. Enalapril dosage in steroid-resistant nephrotic syndrome. Pediatr Nephrol. 2004 Jan;19(1):45-50. Epub 2003 Nov 25. DOI:10.1007/s00467-003-1314-y
37. Yi Z, Li Z, Wu XC, HeQN, Dang XQ, He XJ. Effect of fosinopril in children with steroid resistant idiopathic nephrotic syndrome Pediatr Nephrol 2006;21:967-972
38. Hodson EM, Habashy D,Craig JC Interventions for idiopathic steroid resistant nephritic syndrome in children(Cochrane review) From the Cochrane Library, Issue 3, 2006.
39. Zietse R, Derkx FH, Schalekamp MA, Weimar W. Cyclosporin and the glomerular filtration barrier in minimal change disease and membranous glomerulopathy. Contrib Nephrol. 1995;114:6-18.[pubmed]
40. Borel JF, Feurer C, Gubler HU, Stähelin H. Biological effects of cyclosporin A: a new antilymphocytic agent. 1976. Agents Actions. 1994 Dec;43(3-4):179-86.[pubmed]
41. E. R. Maher, P. Sweny, M. Chappel, Z. Varghese and J.F. Moorhead Cyclosporin in the treatment of steroid responsive and steroid resistant Nephrotic syndrome in adults Nephrol Dial Transplant 1988; 3: 728-732
42. Hymes LC. Steroid-resistant, cyclosporine-responsive, relapsing nephrotic syndrome. Pediatr Nephrol. 1995 Apr;9(2):137-9.[pubmed]
43. Hafeez F, Ahmad TM, Anwar S. Efficacy of steroids, cyclosporin and cyclophos-phamide in steroid resistant idiopathic nephrotic syndrome. J Coll Physicians Surg Pak. 2005 Jun;15(6):329-32. DOI:06.2005/JCPSP.329332.[pubmed]
44. Tejani A Suthanthiran M, Pomrantz A. A randomized controlled trial of low dose prednisone and ciclosporin versus high dose prednesone in nephritic syndrome of children. Nephron 1991;59:96-99
45. Niaudet P.Treatment of childhood steroid resistant idiopathic nephrosis with a combination of cyclosporine and prednisone. French Society of Pediatric Nephrology. J Pediatr 1994;125: 981-986
46. Gregory MJ, Smoyer WE, Sedmanet Long term cyclosporine therapy for pediatric nephritic syndrome . : A clinical and histologic analysis. J Am Soc Nephrol 1996; 7:543,
47. Ponticelli C, Edefonti A, Ghio L, et al. Cyclosporin versus cyclophosphamide for patients with steroid-dependent and frequently relapsing idiopathic nephrotic syndrome: a multicentre randomized controlled trial. Nephrol Dial Transplant. 1993;8(12):1326-32.[pubmed]
48. Ingulli E, Singh A, Baqi N, et al. Aggressive, long-term cyclosporine therapy for steroid-resistant focal segmental glomerulosclerosis. J Am Soc Nephrol. 1995 Apr;5(10):1820-5.[pubmed]
49. Plank C, Kalb V, Hinkes B, Hildebrandt F, Gefeller O, Rascher W; Arbeitsgemschaft fur Padiatrische Nephrology. Cyclosporine A is superior to cyclophosphamide in children with steroid resistant nephrotic syndrome- a randomized controlled multicenter trial by the Arbeitsgemschaft fur Padiatrische Nephrology. Pediatr Nephrol 2008;DOI 10.1007/s00467-008-0794-1
50. Ponticelli C, Rizzoni G, Edefonti A, et al. A randomized trial of cyclosporine in steroid-resistant idiopathic nephrotic syndrome. Kidney Int. 1993 Jun;43(6):1377-84. [pubmed]
51. Lieberman KV , Tezani A. A randomized double blind placebo controlled trial on cyclosporine in SR FSGS in children J Am Soc Nephrol 1996;7; 56-63.[pubmed]
52. Valerie Leroy. Veronique Baudouin. Corinne Alberti. Genevieve Guest.Patrick Niaudet. Chantal Loirat. Georges Deschenes. Paul Czernichow. Dominique Simon Growth in boys with idiopathic nephritic syndrome on long- term cyclosporine and steroid treatment Pediatr Nephrol(2009) 24:2393-2400
53. Cattran DC, Rao P. Long term outcome in children and adults with classic focal segmental glomerulosclerosis. Am J Kidney Disease 1988;32: 72-79.[pubmed]
54. Adhikari M, Coovadia HM Cyclosporin in SRNS S Afr Med J 1994 Nov;(11);783-6
55. J Li, Q Li, J Lu and Z Li : Immunosuppression therapy in children with steroid resistant nephrotic syndrome. Iran J Pediatr. 2018;28(1): e11567. Doi 10,5812/ijp. 11567
CITATION
DOI: 10.17511/ijpr.2018.i11.06
Published: 2018-11-30
How to Cite
Dr Dipti Devi. (2018). Long-term therapy with cyclosporine and alternate-day prednisone in patients with idiopathic Steroid Resistant Nephrotic Syndrome (SRNS). Pediatric Review: International Journal of Pediatric Research, 5(11), 582-591. https://doi.org/10.17511/ijpr.2018.i11.06
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Copyright (c) 2018 Author (s). Published by Siddharth Health Research and Social Welfare Society
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