Comparion Of Prednisolone Plus Cyclosporine A With Prednisolone Alone For Treatment In Children With Steroid-Resistant Nephrotic Syndrome

Objectives: Primary nephrotic syndrome (PNS) is the most common glomeurlardisease in childhood. On the basis of the patients’ response to glueocorticosteroidtherapy, PNS has been divided into steroid-sensitive nephrotic syndrome (SSNS) andsteroid-resistant nephrotic syndrome (SRNS). Approximate80-90%of all PNSchildren respond to steroid treatment and show favourable outcomes;10-20%ofpatients are resistant to typical steroid treatment, and30-40%of cases with SRNSmay progress to end-stage renal disease (ESRD). Management of SRNS in children ischallenging. There is no uniform treatment prescription. Studies about the efficacy ofprednisolone plus cyclosporine A versus prednisolone alone in children withsteroid-resistant nephritic syndrome have not been definited. This study wasundertaken to compare the efficacy of prednisolone plus cyclosporine A with that ofprednisolone alone for the treatment in children with SRNS.Methods: Twenty-six patients diagnosed with childhood SRNS were recruitedinto our study at the Department of Pediatrics of Fuzhou General Hospital of NanjingCommand from December2005to December2011, which we had a retrospectiveanalysis about these patients.Results: After completion of the initial treatment, the sustained remission time inthe prednisolone alone group range from11to98days and in the prednisolone pluscyclosporine A group range from20to417days. In the prednisolone pluscyclosporine A group, the first relapse occurred later compared with the prednisolonealone group. After1year, the relapse rate was lower in the prednisolone pluscyclosporine A group. After3month, prednisolone plus cyclosporine A therapyprotocol produced a complete remission of proteinuria in12patients (66.67%) and apartial remission in4patients (22.22%). After12mouths, the proportion of patientswho experienced relapse was46.2%. The time to complete or partial remission rangesfrom4to90days in prednisolone plus cyclosporine A group.Conclusion: Prednisolone plus cyclosporine A is more effective than prednisolone alone in maintaining remission time and reducing risk of relapses inchildren with SRNS.