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The use of steroid-sparing agents in steroid-sensitive nephrotic syndrome

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Abstract

Childhood nephrotic syndrome (NS) is frequently characterized by a relapsing course. There is no uniform agreement about the precise stage at which a steroid-sparing agent should be introduced to control the disease. In order to evaluate the treatment strategies and outcome of steroid-sensitive NS over the last 2 decades, a retrospective notes review was undertaken in a cohort of children treated at Great Ormond Street Children's Hospital between 1980 and 2000. From a population of 863 children with NS referred, 509 had frequently relapsing or steroid-dependent disease and 261 children received at least one steroid-sparing agent. Cyclophosphamide was the first choice in 178 patients and in 114 no further steroid-sparing agent was needed. Levamisole was prescribed as the first steroid-sparing agent for 65 children and disease control was achieved in 30%. Cyclosporin A was prescribed in 61 children and sustained remission was induced in 69%. It is concluded that cyclophosphamide is a potent agent in inducing sustained remission in steroid-sensitive NS. Levamisole and cyclosporin A have emerged as attractive steroid-sparing agents. Complications and major side effects of treatment are infrequent but occasionally fatal.

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Acknowledgements

A.A. was supported by The Caring for Kids Fund (Child Health Research Appeal Trust).

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Authors and Affiliations

  1. Nephro-Urology Unit, Institute of Child Health, 30 Guilford Street, London WC1 N 1EH, UK

    Asiri S. Abeyagunawardena, Michael J. Dillon, Lesley Rees, William van't Hoff & Richard S. Trompeter

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  1. Asiri S. Abeyagunawardena
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  2. Michael J. Dillon
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  3. Lesley Rees
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  4. William van't Hoff
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  5. Richard S. Trompeter
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Correspondence to Richard S. Trompeter.

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Abeyagunawardena, A.S., Dillon, M.J., Rees, L. et al. The use of steroid-sparing agents in steroid-sensitive nephrotic syndrome. Pediatr Nephrol 18, 919–924 (2003). https://doi.org/10.1007/s00467-003-1216-z

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  • DOI: https://doi.org/10.1007/s00467-003-1216-z

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