Remission rates and long-term outcomes of relapsed pediatric nephrotic syndrome: cyclophosphamide vs. cyclosporin A.

BACKGROUND

Immunosuppressive drugs are required for childhood frequent-relapse nephrotic syndrome (FRNS), steroid-dependent NS (SDNS), or steroid-resistant NS (SRNS). However, the benefits of immunosuppressants need to be balanced with their known side effects. This study aimed to compare remission rates of FRNS, SDNS, and SRNS in children treated with cyclophosphamide versus cyclosporin A (Cy A).

METHODS

We retrospectively reviewed the medical records of children diagnosed with NS at Prince of Songkla University Hospital, Thailand. Remission rates and complications in patients with FRNS/SDNS and SRNS were compared among those treated with oral cyclophosphamide, Cy A, or cyclophosphamide followed by Cy A.

RESULTS

Among 148 children (102 boys, 68.9%), the median age was 4.6 years (IQR 2.5-8.4). FRNS, SDNS, and SRNS were diagnosed in 37 (25.0%), 50 (33.8%), and 61 (41.2%) children, respectively. Among 87 FRNS/SDNS patients, 67 were treated with cyclophosphamide, 2 with Cy A, and 18 with cyclophosphamide followed by Cy A. There were no statistically significant differences in remission rates or complications among the treatment groups. Among 61 SRNS patients, 27 were treated with cyclophosphamide, 11 with Cy A, and 23 with cyclophosphamide followed by Cy A. The remission rates were 29.6%, 72.7%, and 43.5%, respectively. Acute kidney injury (AKI) was reported in 14.8%, 18.2%, and 52.2% of patients, respectively.

CONCLUSIONS

In FRNS/SDNS patients, remission rates were comparable between cyclophosphamide and Cy A treatments. In SRNS patients, Cy A treatment resulted in a higher remission rate than cyclophosphamide but was associated with a greater incidence of AKI.