The evaluations of cyclophosphamide (CY) in the treatment of adults patients with primary nephrotic syndrome are obscure, except minimal change nephrotic syndrome (MCNS). The present trial has been designed to evaluate the effects of CY combined with prednisolone in conventional dosage. Now, we investigate the effects, side effects and influence of CY on lymphocyte during treatment. Material: Ninty-eight patients with primary nephrotic syndrome in Nagoya University Hospital from 1975 to 1979 were examined. Twenty-five of them were resistent or relapse to steroid. We medicated CY to these 25 patients. The hi stological diagnosis consisted of 8 MCNS, 7 memranous nephropathy (MN), 9 diffuse proliferative glomerulonephritis (DPGN), 1 focal glomerulonephrits (FGS). Method: CY 2-3 mg per kg per day plus maintenance prednisolone 20 mg per day was given. Routine examination including renal function, skin reaction and lymphocyte function were carried out after and defore treatment. Results: all patients in MCNS, 3/6 patients in MN, 1/8 patients in DPGN and 0/1 FGS were CY effective in patients with duration of CY administration more than 8 weeks. DNCB and PHA-P skin reaction are significantly low, comparing with controls. On the contrary suppressor cell activity (Show's method) has significantly incresad. (P<0.05) Immunoglobulin-prodution activity in patient's lymphocyte decreased. Discussion and Conclusion: It is sure that the mechanism of chronicity in glomerulonephritis has correration closely with immune mechanism. CY suppresses immune responce for along time, after and before antigen stimulation. From the point of view, CY is on important medicine that would be expected to be effective in steroid resistent nephrotic syndrome or frequently relapsing neqhrotic syndrome. The responce to treatment has been assessed not only by reference to clinical state and urinary protein, but also lymphocyte function in nephrotic patients. Eleven patients responded but the remainders were unsatisfactory. These data show that CY is effective in some cases. Several parameters we measured were not available for the evaluation of the effects of CY. That is, there is no difference between CY plus prednisolone and prednisolone, especially, in skin reaction and suppressor cell activity. CY has the side effects of dose-related hematopoietic-cell depression, alopecia, nausea, interstitial hemorrhagic cystitis, and so on. These results suggest careful f ollowup observation of patients. Cyclophosphamide therapy is an effective alternative for nephrotic patients with MCNS who develop steroid dependence or resistence, and for some nephrotic patients with membranous glomerulonephritis.
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