Ciclosporin (CyA) in Steroid-Insensitive Nephrotic Syndrome in Durban, South Africa
The nephrotic syndrome (NS) among African children in South Africa has many features which make it quite distinct from the disease among children in most other parts of the world . In some respects, especially the relationship with quartan malaria, the syndrome among black South Africans is different even from that in tropical Africa . The commonest histological category among these patients is membranous nephropathy which appears to be causally linked to HBsAg . The nature of the Hbs infection is invariably the carrier state. The outcome in these children is not entirely clear as follow-up studies are exceedingly difficult in the third world. However, about one third go into remission, a third have persistent proteinuria and the remainder have severe proteinuria with oedema. Morbidity is significant in the last-mentioned group with repeated hospital admissions for severe oedema. Management is quite unsatisfactory and nothing remotely like the success of steroids or cytotoxics in minimal change has been achieved. A high protein diet (expensive and often unattainable among black patients), diuretics and intravenous 20% salt-free albumen have been the mainstay of therapy. Accordingly treatment for this condition has to be innovative.
KeywordsCreatinine Malaria Cyclosporin Proteinuria Glomerulonephritis
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