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International Journal of Nephrology
Volume 2011, Article ID 930965, 4 pages
http://dx.doi.org/10.4061/2011/930965
Clinical Study

Treatment of Steroid and Cyclosporine-Resistant Idiopathic Nephrotic Syndrome in Children

1Urology-Nephrology and Transplantation Research Centre, Department of Paediatric Nephrology, Urmia University School of Medicine, Iran
2School of Medicine, Urmia University, Iran

Received 23 May 2011; Revised 17 July 2011; Accepted 18 July 2011

Academic Editor: R. Khanna

Copyright © 2011 A. A. Nikibakhsh et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Steroid-resistant nephrotic syndrome (SRNS) in children carries a significant risk of progression to end-stage renal failure (ESRF). We report a two-step protocol adapted in children with SRNS. Thirty-seven SRNS were treated with cyclosporine A (CyA) in association with prednisolone (alternate day) for 6 months (first-step treatment). Twelve patients (32.4%) went into complete remission, and 2 (5.4%) got partial remission. The other 23 cases who were steroid and CyA resistant entered a second-step treatment with withdrawing steroids, with CyA (5 mg/kg/day) in association with mycophenolate mofetil (MMF) 30 mg/kg/day for 6 months. Complete remission was observed in 11 cases (47.82%) and partial remission in 2 cases (8.7%). After two steps of treatment, 27/37 children went into total remission. In steroid and CyA-resistant INS, the association of MMF with CyA was able to induce remission in about half cases without relevant side effects.