|
| Treatments | Description/usefulness | Drawback/limitation | Target molecule/cell |
|
| Mizoribine (imidazole) | (i) Reduced relapse rate and prolonged remission were reported [130]
(ii) Provides protective effects against CsA nephrotoxicity [131]
(iii) Replacement immunosuppressive agent of azathioprine due to lower toxicity for childhood nephrotic syndrome and steroid-resistant nephrotic syndrome [80] | (i) Not widely used due to low efficacy [80]
(ii) Not recommended for use in children [132] | (i) Inhibition of DNA synthesis, specifically to lymphocyte proliferation [80] |
|
| Azathioprine (imidazole) | (i) Complete remission was reported but only in 1 patient out of 20 [30] | (i) Not effective to prevent relapse in nephrotic syndrome children [133]
(ii) Ineffective result had been noted [134]
(iii) Not well documented [135]
(iv) Not recommended for use in children [132] | (i) Inhibition of DNA synthesis, specifically to lymphocyte [136] |
|
| Pefloxacin | (i) Disappearance of proteinuria reported in frequent relapse nephrotic syndrome patient [87] | (i) Extremely limited evidence and studies, result only based on 1 patient [86]
(ii) Toxicity towards joints, ankle, knee, and neck was reported [87] | (i) Unclear [85], lack of studies in nephrotic syndrome |
|
| Mechlorethamine (alkylating agent) | (i) Reduce the frequency of relapse in patients [88] | (i) Extremely limited evidence and studies, result only based on less than 5 patients [86] | (i) Unclear, lack of studies in nephrotic syndrome |
|
| Sirolimus (mammalian target of rapamycin (mTOR) inhibitor) | (i) Suggested as potential approach [2]
(ii) Been used together with cyclosporine in 2 patients but the result is unclear [100]
(iii) More commonly used in kidney transplant patients | (i) Anemia as commonly noted side effect [137], the most common side effect is hyperlipidemia [62]
(ii) Studies showed sirolimus itself might have caused proteinuria [138]
(iii) Most studies were FSGS related instead of MCD | (i) Inhibit proliferation of T lymphocytes, fibroblast, endothelial, mesangial, and smooth muscle cells [138] |
|
| Galiximab (antibody) | (i) Potential approach | (i) Never tested or used in kidney-related disease | (i) CD80 [82] |
|
| Basiliximab (antibody) | (i) Effective single dose to achieve complete remission and remission was reported [70, 139] | (i) Addition of basiliximab to treatment did not improve clinical outcome [140] | (i) Interleukin-2 [89, 139]
(ii) CD25 [70] |
|
| Adalimumab (antibody) | (i) Subgroup that is TNF associated could be partially benefited [141] | (i) Studies conducted but no available result [15]
(ii) Not suggested further in resistant FSGS [141]
(iii) Studies in FSGS patients, lack of MCD focused | (i) Tumor necrosis factor-α (TNF-α) |
|
| Galactose | (i) Proteinuria reduction and kidney function preservation were reported [141]
(ii) Remission of nephrotic syndrome in multiple immunosuppressant-resistant patient was reported [142] | (i) Studies conducted but no available result [15]
(ii) Studies in FSGS patients, lack of MCD focused | (i) High affinity with FSGS permeability factor [142] |
|
| Thiazolidinediones (synthetic peroxisome) | (i) Evidences of reduced proteinuria, microalbuminuria, podocyte injury, vascular injury, inflammation, and fibrosis were reported [110]
(ii) Podocyte protective feature was noted, could possibly be the potential therapy due to the similar response of glucocorticoids [110] | (i) Most studies focus on diabetic nephropathy and nondiabetic glomerulosclerosis, lack of studies in MCD patients | (i) Activation of the glucocorticoid receptor [110]
(ii) Decrease transforming growth factor production [143] |
|
| Everolimus (mTOR inhibitor) | (i) Cytoskeleton stabilizing effect reported for the first time in 2013 [144]
(ii) Lack of studies, especially in MCD | (i) Potentially worsen kidney’s health and proteinuria [145]
(ii) Lesser data than sirolimus [146]
(iii) Mostly renal transplant focused instead of MCD | (i) Inhibition of T cell proliferation
(ii) RhoA signaling [144] |
|
| Fresolimumab | (i) Partially achieved remission and reduce proteinuria in FSGS [147] | (i) FSGS patient studies, not MCD | (i) Transforming growth factor-beta [147] |
|
| Sparsentan | (i) Reduced proteinuria was reported [148] | (i) FSGS patient studies, not MCD | (i) Endothelin type A and angiotensin II type 1 receptor [147] |
|
