Treatment of Steroid Resistant Nephrotic Syndrome


Background: The therapy of nephrotic syndrome with steroid resistance is still a matter of controversy. Optimal therapy for glucocorticoid-resistance MCD is not well defined. A prospective study was done on children who attained Tikrit Teaching Hospital and Beji General Hospital during the period from 1st of July 2004 to the end of July 2006.Objective: To find out the benefit of immunosuppressive therapy (IV methylprednisolone followed by oral prednisolone therapy for one year along with six doses of monthly pulses of cyclophosphamide) for children with steroid resistant nephrotic syndrome. Patients & Methods: Thirty-four children with steroid resistant nephrotic syndrome were treated with above regime. The remission of the disease was determined at the end of first and second year. Results: The above protocol could induce and maintain remission in 81.8% (9/11) of children with minimal change nephrotic syndrome, 66.7% (6/9) of children with diffuse mesangial proliferation and in only 16.7% (1/6) of children with focal segmental glomerulosclerosis at the end of two years of the study. The therapy of IV methylprednisolone followed by oral prednisolone for one year plus 6 month pulse cyclophosphamide intravenously is beneficial for children with steroid resistant minimal change disease and diffuse mesangial proliferative glomerulonephritis. The therapy is not effective in focal segmental glomerulosclerosis.Key words: Cyclophosphamide, Methyl prednisolone, Steroid resistant nephrotic Syndrome