Pediatric Nephrology

, Volume 5, Issue 5, pp 617–619 | Cite as

Kidney biopsy prior to cyclophosphamide therapy in primary nephrotic syndrome

  • Tej K. Mattoo
Brief Report


The study includes 30 children, 10 each with minimal change nephropathy (MCNS), diffuse mesangial proliferative glomerulonephritis (MesPGN) and focal segmental glomerulosclerosis (FSGS). Indications for kidney biopsy were: steroid resistance in 12 cases, and frequent relapses on maintenance steroid therapy in 18 cases. A 2-year remission was achieved by cyclophosphamide therapy in 6 patients with FSGS, 8 patients with MCNS and 8 patients with MesPGN. In terms of initial response to corticosteroids, only 3 of 8 patients with early steroid resistance responded to cyclophosphamide therapy compared with 3 of 4 with late steroid resistance and 16 of 18 with frequent relapses on maintenance steroid therapy. Response to cyclophosphamide therapy correlates better with the initial corticosteroid response than renal histopathology. A kidney biopsy prior to administration of cyclophosphamide is not essential in patients who respond to initial corticosteroid therapy.

Key words

Nephrotic syndrome Renal biopsy Cyclophosphamide therapy 


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  1. 1.
    Berns JS, Gaudio KM, Krassner LS, Anderson FP, Durant D, McDonald BM, Seigal NJ (1987) Steroid responsive nephrotic syndrome of childhood: a long term study of clinical course, histo-pathology, efficacy of cyclophosphamide therapy, and effects on growth. Am J Kidney Dis 9: 108–114Google Scholar
  2. 2.
    International Study of Kidney Disease in Children (1981) The primary nephrotic syndrome in children: identification of patients with minimal change nephrotic syndrome from initial response to prednisolone. J Pediatr 98: 561–564Google Scholar
  3. 3.
    Schulman SL, Kaiser BA, Polinsky MS, Srinivasan R, Baluarte HJ (1988) Predicting the response to cytotoxic therapy for childhood nephrotic syndrome: superiority of response to corticosteroid therapy over histopathologic patterns. J Pediatr 113: 996–1001Google Scholar
  4. 4.
    Vernier RL (1987) Primary (idiopathic) nephrotic syndrome. In: Holliday MA, Barratt TM, Vernier RL (eds) Pediatric nephrology, 2nd edn. Williams and Wilkin, Baltimore, pp 445–456Google Scholar
  5. 5.
    Churg J, Habib R, White RHR (1970) Pathology of nephrotic syndrome in children. Lancet I: 1299–1302Google Scholar
  6. 6.
    Rosen S, Galvanek E, Levy M, Habib R (1981) Glomerular disease. Hum Pathol 12: 964–977Google Scholar
  7. 7.
    Cohen AH, Border WA, Glassock RJ (1978) Nephrotic syndrome with glomerular mesangial IgM deposits. Lab Invest 38: 610–619Google Scholar
  8. 8.
    Tejani A (1985) Morphological transition in minimal change nephrotic syndrome. Nephron 39: 157–159Google Scholar
  9. 9.
    Jennette JC (1981) Evolution of mesangial IgM nephropathy into focal segmental glomerulosclerosis. Am J Nephrol 1: 222Google Scholar
  10. 10.
    Habib R, Kleinkneckt C (1971) The primary nephrotic syndrome of childhood: classification and clinicopathologic study of 406 cases. Pathol Annu 6: 417–474Google Scholar
  11. 11.
    Siegel NJ, Gaudio KM, Krassner LS, McDonald BM, Anderson FP, Kashgarian M (1981) Steroid-dependent nephrotic syndrome in children: histopathology and relapses after cyclophosphamide treatment. Kidney Int 19: 454–459Google Scholar
  12. 12.
    Barratt TM, Bercowsky A, Osofsky SG, Soothill JF, Kay R (1975) Cyclophosphamide treatment in steroid-sensitive nephrotic syndrome of childhood. Lancet I: 55–58Google Scholar
  13. 13.
    Arbus GS, Poucell S, Bacheyie GS, Baumal R (1982) Focal segmental glomerulosclerosis with idiopathic nephrotic syndrome: three types of clinical response. J Pediatr 101: 40–45Google Scholar

Copyright information

© IPNA 1991

Authors and Affiliations

  • Tej K. Mattoo
    • 1
  1. 1.Department of Paediatric NephrologyMaternity and Children's HospitalRiyadhSaudi Arabia

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