Options of the Treatment in Steroid Resistant Nephrotic Syndrome in Children in Central Child Teaching Hospital-Baghdad


ABSTRACT: BACKGROUND: The therapy of steroid resistant nephrotic syndrome (SRNS) is still a matter of controversy. OBJECTIVE: To assess the options of treatment in SRNS PATIENT AND METHOD: A retrospective study to 50 patients randomly selected in the Central Child Teaching Hospital during study period from Jan. 2006 to July 2008. The patients age were between 6 months.-18 years. All patients who had failed to achieve an improvement in proteinuria after minimum of 4 weeks (up to 8 weeks) of prednisolone (PDN) in a dosage 2 mg/kg/day were taken. Only the patients with idiopathic nephrotic syndrome (45 patients) were involved in the study but the patients with secondary nephrotic syndrome and congenital neprosis were excluded from the study. Each patient were individualized to the type of pathology and to the type of medication used. RESULTS: Forty five patients were included in the study, the age range between 6 months.-18 years. Twenty eight patients were male and 17 were female, M: F ratio 1.64: 1. Regarding the type of pathology, 20 patients with focal segmental glomerulosclerosis (FSGS), 11 patients with minimal change nephrotic syndrome (MCNS), 8 patients with diffuse mesangial proliferation (DMP) and 6 patients were unknown biopsy (not down biopsy). The drugs that used were methyl prednisolone (MP) in 17 patients, Every other day steroid (EODS) in 10 patients, cyclosporineA (CsA) plus EODS in 16 patients (10 patients as first option and 6 patients as second option), cyclophosphamide (CYS) used in 8 patients (6 patients as first option and 2 patients as second option) and chlorambucil were used in 2 patients only. The response was higher in patients who received EODS (50%), followed by the patients who received CsA plus EODS (25%) then the patients who received MP(23.5%) and the patients who received CYS(12.5%) and chlorambucil(zero%). The response to treatment was higher in females than males, 11 out of 28 males (39.28%) responded to treatment while 7 of 17 female (41.17%) responded to treatment. The patients with early presentation responded to treatment higher than those with late presentation, so 12 of 19 patients (63.15%) presented early while 10 of 26 patients (38.46%) presented late. According to histopathology, the patients with unknown etiology had higher rate of response, 3 out of 6 patients (50%) responded to treatment followed by 7 of 20 (35%) patients with FSGS, then 2 of 8 (25%) patients with DMP, then 2 of 11 (18.18%) patients with MCNS. CONCLUSION: The drugs used are the common drugs and EODS is preferable type of medication used in SRNS