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Failure of steroid treatment in nephritic syndrome

Explore various treatment options for nephrotic syndrome, including dosage, remission rates, side effects, and cautions of steroid, cyclophosphamide, cyclosporine, levamisole, mycophenolate mofetil, and other medications. Learn about monitoring guidelines and potential risks related to each treatment.

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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

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