Abstract
We retrospectively analyzed 20 prepubertal children with steroid-dependent nephrotic syndrome (SDNS) who had been treated with cyclophosphamide (CPM: 1.5-2.5 mg/kg per day) for 12 weeks (cumulative dose within 200 mg/kg) as first-line therapy of immunosuppressive agents. Mean duration of follow-up was 36.2 (range 9-72) months. Twelve of 20 children (responders: 60%) showed a long-term remission or infrequent relapsing NS, while 8 of 20 (non-responders: 40%)developed relapses again when the dose of prednisolone (PSL) tapered to 0.5 mg/kg per alternate days and were subsequently treated with cyclosporine (CsA). Furthermore, we analyzed patient's steroid threshold, (i.e. the dose of PSL at which the relapses occurred) before the initiation of CPM using 1 mg/kg per alternate days as a cut-off points. The patients of responders whose PSL threshold levels were less than 1 mg/kg per alternate days responders were significantly higher than those of non-responders (p=0.025). In conclusions, CPM as first-line therapy of immunosuppressive agents may be tried if prepubertal patients develop steroid dependency. If possible, we recommend that CsA is given only to midpubertal children with SDNS.
