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Failure of steroid treatment in nephritic syndrome

Failure of steroid treatment in nephritic syndrome

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Failure of steroid treatment in nephritic syndrome

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  1. Failure of steroid treatment in nephritic syndrome

  2. Cyclophosphamide • Dosage : 2.5-3 mg/kg/day for 8-12 wks • 2-yr remission rate : 60 % • Alternate-day prednisolone therapy is often continued • Side effects : leukopenia, hemorrhagic cystitis, alopecia, sterility, and long-term risks of hematologic malignancy • Cautions : WBC must be monitored, withheld if < 3000/mm3

  3. Cyclosporine • Dosage : 3-5 mg/kg/day for 6-12 mo • Remission rate : 75% in steroid-dependent relapser • Relapse is common within 3 months of stopping treatment (52%) • Side effects : nephrotoxicity, HTN, gingival hyperplasia, hirsutism • Cautions : Monitor blood level, Cr, BP

  4. Levamisole • Dosage : 2.5 mg/kg on alternate days • Immunomodulatory effect ? • Most relapse within 3 months of stopping the drug, but provide a relatively nontoxic alternative to steroid until spontaneous remission occurs • Side effects: liver toxicity, vasculitic rash, reversible neutropenia, encephalopathy  rare

  5. Mycophenolate Mofetil(CellCept) • Dosage: 0.8-1.2 g/m2/day • Preliminary study demonstrates that children with frequently relapsing MCNS may be beneficial with MMF without major side effects. • Side effects: Leukopenia, GI discomfort, diarrhea, malaise

  6. Others • Chlorambucil • dosage : 0.2 mg/kg/day for 2 months • similar effect to cyclophosphamide • Azathioprine • not proven in the management of children with minimal change dz • Pulse methylprednisolone • Pulse cyclophosphamide