Farkhanda Hafeez, Tahir Masood Ahmad, Sumair Anwar.
Efficacy of steroids, cyclosporin and cyclophosphamide in steroid resistant idiopathic nephrotic syndrome.
J Coll Physicians Surg Pak Jan ;15(6):329-32.

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.

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