Page 1 of 1: paeds -nephrotic syndrome

manpreet108 · Credits: 30682 My Scrapbook

what is the treatment in case of steroid resistant nephrotic syndrome???

nutsnitin · Credits: 15164 My Scrapbook

harry says...

Cytotoxic agents may also induce remission in occasional steroid-resistant cases. These benefits must be balanced against the risk of infertility, cystitis, alopecia, infection, and secondary malignancies, particularly in children and young adults. Azathioprine has not been proven to be a useful adjunct to steroid therapy. Cyclosporine induces remission in 60 to 80% of patients; it is an alternative to cytotoxic agents and an option in patients who are resistant to cytotoxic agents. Unfortunately, relapse is usual when cyclosporine is withdrawn, and long-term therapy carries the risk of nephrotoxicity and other side effects.

hardcoremallu · Credits: 14786 My Scrapbook My Reading List 6 Books

is the answer enalapril
i couldnt see the answer in books
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manpreet108 · Credits: 30682 My Scrapbook

i cant open this link....

i was thinking ans cd be cyclosporine -- and nitin has some ref too for it..
ghai only says that levamisole and cyclophosphamide are useful in steroid responsive relapses.--and cyclosporine is effective when thses two dont work....

any thing specific --u cd find in favor of enalapril hcm[hey yr name is too big to type every time]

hardcoremallu · Credits: 14786 My Scrapbook My Reading List 6 Books

this is a recent study, i think conducted my maulana azad medical college
steroid resistancedefined as unresponsive proteinuria even after 8 weeks of adequate therapy with steroids.
preliminary reports had demonstrated antiproteinuric effect of ACE inhibitors in renal disorders with varying levels of blood pressure, proteinuria and they found a significant reduction of blood pressure and MAP.
mechanism by which enalapril reduces proteinuria is not known it has been postulated to be due to decrease in systemic blood pressure or GFR or both.
ACE inhibitors reduce glomerular capillary pressure while angiotensin II acts as a growth promoter of mesangial cells and vascular smooth muscles.
Hence inhibition of Angiotensin II by ACE inhibitors results in control of glomerular hypertension as well as inhibition of mitogenesis of mesangial cells and matrix thereby reducing macromolecule passage through GBM via conformational changes and hence causing a reduction in proteinuria.
Enalapril is a safe drug with no serious side effects or deterioration in renal function noticed in any patient. It was effective in reducing proteinuria in steroid resistant nephrotic syndrome and this effect was not related to decrease in BP or GFR and seems to be due to a specific intraglomerular action.It also has a beneficial effect on serum proteins and lipid profile and may decrease morbidity and extrarenal complications of nephritic syndrome. Further long term studies are needed to estimate the efficacy of ACE inhibitors .

drprasu · Credits: 5745 My Scrapbook

nelson says that steroid resistant cases are treated by extended tt with cyclophosphamide or high dose steroid or cyclosporine.....

parin · Credits: 14560 My Scrapbook My Reading List 1 Books

Steroid resistant cases are treated by cytotoxic agents. Here are the options:

Cyclophosphamide:

2-3 mg/kg/d SD for 4-8 wks, often with alternate day corticosteroids
monitor WBC wkly & discontinue if < 5000/cmm
can cause nausea, vomitting, haemorrhagic cystitis, neutropenia, alopecia, sterility, disseminated varicella, increased risk for future malignancy....

High dose pulse methylprednisolone:

30 mg/kg bolus(max 1000 mg), with 1st 6 doses every other day f/b tapering regiment for periods upto 18 months

Cyclosporine:

3-6 mg/kg/d SD
can cause hypertension, nephrotoxicity, hirsuitism, gingival hyperplasia..
main problem is relapse on discontinuation..

ACE inhibitors & AT II blockers:

they are used as adjunct to reduce proteinuris in steroid-resistant cases..

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