Article

Non-corticosteroid immunosuppressive medications for steroid-sensitive nephrotic syndrome in children

Centre for Kidney Research, The Children's Hospital at Westmead, Locked Bag 4001, Westmead, NSW, Australia, 2145.
Cochrane database of systematic reviews (Online) (Impact Factor: 6.03). 10/2013; 10(10):CD002290. DOI: 10.1002/14651858.CD002290.pub4
Source: PubMed

ABSTRACT

Children with nephrotic syndrome lose excessive amounts of protein from their bloodstream into their urine, causing swelling, especially in the face, stomach and legs. The risk of infection also increases because important proteins used by children's immune systems have been lost. Corticosteroid drugs, such as prednisone, can stop protein loss, but often happens again (relapse). Giving children further corticosteroids can lead to poor growth, cataracts, osteoporosis and high blood pressure. To find out if there was evidence about non-corticosteroid drugs for children with nephrotic syndrome, and to assess what the benefits and harms of these drugs were, we analysed 32 studies that enrolled 1443 children. The studies compared several drugs and found that cyclophosphamide, chlorambucil, cyclosporin, levamisole and rituximab reduced the risk of relapse in children with frequently relapsing steroid-sensitive nephrotic syndrome. We found that more studies are needed that compare different drug treatments to determine how these medicines should be used in children with nephrotic syndrome.

Download full-text

Full-text

Available from: Elisabeth M Hodson, May 07, 2015
  • [Show abstract] [Hide abstract]
    ABSTRACT: Glomerular diseases are traditionally treated with immunosuppressive and/or anti-inflammatory drugs. In some forms of glomerular disease, this is logical because of what is known about their pathogenesis. However, in podocytopathies including minimal change nephropathy and focal segmental glomerulosclerosis the use of glucocorticosteroids, calcineurin antagonists and other drugs with actions on the immune system is purely empirical. The toxicities of these drugs run the risk of making the treatment worse than the disease, and demand that we work hard to understand their modes of action in glomerular disease and then develop more specific approaches. This article poses the challenge that the key mode of action may be direct actions on podocytes themselves and that future therapies should focus on the podocyte as the therapeutic target, not the lymphocyte. (C) 2014 S. Karger AG, Basel
    No preview · Article · Jan 2014 · Contributions to nephrology
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Objectives of study: The adolescent population signifies the transitory period where the frequent occurrence of different histopathological lesions in patients with nephrotic syndrome (NS) is different from that seen in young children as well as that seen in adults. This study aimed to analyze the clinical features and histopathological spectrum of adolescent-onset NS. Material and methods: We retrospectively evaluated clinical features, biochemical investigations and histopathology of 103 children with idiopathic NS referred to the Pediatric Department, County Hospital of Târgu-Mureş. Fourteen patients with congenital-, infantil- and secondary NS were excluded from this study. Results: The patients were divided into 2 groups: in group A we included 69 patients diagnosed with NS diagnosed before 10 years-old, with a median age of 3.76±1.96 years, majority males (59.42%) and presenting the pure form of NS. On the other hand, in group B we included 20 adolescents having the median age at the onset of the disease 13.61±2.18 years, with equal distribution of the sexes and presenting the impure form in 65% of cases. The majority of the patients in both groups (68.11% and 70% respectively) responded to steroid therapy. The commonest histopathological subtype in both groups was focal segmental glomerulosclerosis. Conclusions: The incidence of nephrotic syndrome has increased in the last years. The impure form of NS is more frequent in the adolescents than in younger patients. Adolescents with impure and steroid-resistant NS at presentation have other lesions than minimal change disease. The early genetic diagnosis in NS is important for proper clinical management of the patients, prognosis and genetic counseling of the families.
    Full-text · Article · Apr 2014
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Cyclophosphamide continues to have an important role in the treatment of renal disease, including nephrotic syndrome and lupus nephritis, despite known complications of gonadotoxicity and potential infertility in both male and female patients. It is important that the physician recommending this therapy mitigates the effect of the drug on fertility by adhering to recommendations on dosing limits and offering fertility-preserving strategies. In addition to well-established methods, such as sperm banking and embryo cryopreservation, advances in reproductive technology have yielded strategies such as oocyte cryopreservation, resulting in more fertility-preserving options for the pediatric patient. Despite these advances, there continues to be a significant barrier to referral and access to sperm banks and fertility specialists. These issues are further complicated by ethical issues associated with the treatment of pediatric patients. In this review we explore the development of recommended dosing limits and include a discussion of the available fertility-preserving methods, strategies for increasing access to fertility specialists, and the ethical considerations facing the pediatric healthcare provider.
    Full-text · Article · Sep 2014 · Pediatric Nephrology
Show more