Efficacy And Safety Of Combined Therapy With Cyclophosphamide And Calcineurin Inhibitors In Children With Refractory Nephrotic Syndrome

Objective To evaluate the efficacy and side effect of combined therapy with cyclophosphamide(CTX)and calcineurin inhibitors(CNIs)for children with Refractory Nephrotic Syndrome(RNS).Methods Eleven cases,diagnosed with RNS and treated with steroid combined with one immunosuppressant at least before,were collected.All of them were accepted the regimen of combined therapy with CTX,CNI(including tacrolimus and ciclosporin A)and steroid.The partial remission,complete remission,number of relapse and rates of side effects were observed after 3 and 6 months.Results All the enrolled children achieved partial remission 11/11(100%),9 of 11 achieved complete remission(81.8%),and total remission was 100 percent at the 3-month follow-up.11 achieved partial remission(100%),9 complete remission(81.8%)and 11 total remission(100%)at the 6-month observision.Compared with the average of relapse before the multi-target therapy,the median 1.0(1.0-2.0)is more statistically significant(z=-2.889,p=0.004).6 cases appeared hair loss(54.5%).There were 2 cases with gastrointestinal symptoms(18.2%),and 2 cases with bone marrow suppression 18.2(%).One child had higher blood pressure(9.1%),another one had frequent infections(9.1%).Rate of gonadal toxicity and increased levels of blood glucose was 0%.There was on one experienced increasing uric acid and hypertrichosis.Conclusions Combined therapy with cyclophosphamide and calcineurin inhibitors can be a therapeutic option for children with refractory nephrotic syndrome.But side effects of alopecia,gastrointestinal discomfort and bone marrow depression showed a higher rate than gonadal toxicity,hyperglycemia,frequent infections and so on,all of which could take a favourable turn when it discontinued.