Paired trial of cyclophosphamide and prednisone in children with nephrosis.

Cyclophosphamide and prednisone were compared as the primary treatment for the nephrotic syndrome in 27 boys and 4 girls. The patients, aged between 2½ and 11, were paired according to their renal histology; 19 belonged to the minimal change type, 8 to the mild proliferative type, and 4 had diffuse membranous glomerulonephritis but with selective type of proteinuria. The two groups of patients were comparable as regards period of observation before treatment, and duration of follow-up. About half the patients of each group went into spontaneous diuresis, or had no fluid retention, before treatment was started. Cyclophosphamide induced a remission more slowly than prednisone, but remission was less likely to be followed by relapse. Two patients treated with prednisone and one treated with cyclophosphamide still had persistent proteinuria at the time of review. The incidence of cyclophosphamide resistance in nephrosis remains unknown, but is probably not high. Among patients who responded to treatment, duration of persisting proteinuria varied widely, and therefore slow response must be distinguished from true resistance to treatment. Cyclophosphamide should be useful in all patients who relapse after a steroid-induced remission, but its use must be balanced against potential long-term hazards.