Management of Nephrotic Syndrome in Children

Robinson, Renee; Nahata, Milap C.; Mahan, John D.; Batisky, Donald L.

doi:10.1592/phco.23.8.1021.32885

Cited by 12 publications

(19 citation statements)

References 80 publications

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“…Treatment of the FRNS patients remains a great challenge because they often require prolonged courses of steroids with potential for serious side effects and complications (growth failure, cushingoid obesity, hypertension, osteoporosis, cataracts, and psychological disturbances) [2,8,9]. The therapeutic aims are to reduce the rate of relapses, the cumulative dose of corticosteroids, and the incidence of serious complications [10].…”

Section: Introductionmentioning

confidence: 99%

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Long-term effects of levamisole treatment in childhood nephrotic syndrome

et al. 2004

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The effects of levamisole treatment on long-term outcome were evaluated in a retrospective study of frequently-relapsing (FRNS, n=15), steroid-dependent (SDNS, n=13), and steroid-resistant (SRNS, n=6) nephrotic syndrome in 34 children (21 boys, 13 girls, mean age 5.0+/-3.4 years) during a 60-month follow-up period. The definition of frequent relapses was > or = 4 relapses per year. The current relapse was treated with prednisolone 60 mg/m2 per day for 4 weeks, then with 40 mg/m2 every other day for 4 weeks, after which the dose was tapered by 10 mg weekly. From the beginning of the 5th week, levamisole was introduced at a dose of 2 mg/kg per day. The duration of levamisole treatment was 17+/-7 months. Before starting levamisole treatment the mean level of proteinuria was 2.17+/-1.34 g/day and the relapse rate was 4.41/year. By the end of levamisole therapy, proteinuria had fallen to 0.142+/-0.211 g/day and the relapse rate to 0.41/year. No relapse occurred in 23 of the 34 patients during levamisole treatment. In the 24-month follow-up period after the discontinuation of levamisole, 28 children remained in total remission, while 6 had relapses. The cumulative steroid dose before levamisole therapy was 7,564.4+/-3,497.1 mg/year and following the introduction of levamisole 1,472.9+/-1,729.9 mg/year (P<0.0001). We observed reversible neutropenia in 5 patients, but no other side effects were seen. Our findings suggest that in FRNS and SDNS levamisole significantly reduces both the relapse rate and the cumulative steroid dose; therefore, it could be recommended for these patients. In SRNS patients it has also some benefit because proteinuria and the cumulative steroid dose could be reduced significantly.

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Section: Introductionmentioning

confidence: 99%

“…It has been hypothesized to normalize deficient cell-mediated immunity [9]. It enhances T-cell responses by stimulating T-cell activation and proliferation, it potentiates monocyte and macrophage functions, including phagocytosis and chemotaxis, and increases neutrophil mobility, adherence, and chemotaxis [23].…”

Section: Introductionmentioning

confidence: 99%

Long-term effects of levamisole treatment in childhood nephrotic syndrome

et al. 2004

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“…However, due to its adverse reactions, such as hepatotoxicity, CTX has been seldom used in clinical practice. 29 Tacrolimus is also commonly used in clinical practice for the off-label treatment of nephrotic syndrome. Its application in nephrotic syndrome was first used in adults in the 1990s and in paediatric patients in the 2000s.…”

Section: Nephrotic Syndromementioning

confidence: 99%

“…Cyclophosphamide (CTX) has been the first choice for the treatment of refractory nephrotic syndrome in children. However, due to its adverse reactions, such as hepatotoxicity, CTX has been seldom used in clinical practice . Tacrolimus is also commonly used in clinical practice for the off‐label treatment of nephrotic syndrome.…”

Section: Introductionmentioning

confidence: 99%

Off‐label use of tacrolimus in children with glomerular disease: Effectiveness, safety and pharmacokinetics

Hao

Song

Zhang

et al. 2020

Brit J Clinical Pharma

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Glomerular diseases are leading causes of end‐stage renal disease in children. Tacrolimus is frequently used off‐label in the treatment of glomerular diseases. The effectiveness, safety and pharmacokinetic data of tacrolimus in the treatment of glomerular diseases in children are reviewed in this paper to provide evidence to support its rational use in clinical practice. The remission rates in previously published studies were different. In 19 clinical trials on children with nephrotic syndrome, the overall remission rate was 52.6‐97.6%. In four clinical trials on children with lupus nephritis, the overall remission rate was 81.8‐89.5%. In a pilot study with paediatric Henoch‐Schönlein purpura nephritis patients, the overall remission rate was 100.0%. Infection, nephrotoxicity, gastrointestinal symptoms and hypertension are the most common adverse events. Body weight, age, CYP3A5 genotype, cystatin‐C and daily dose of tacrolimus may have significant effects on the pharmacokinetics of tacrolimus in children with glomerular disease. More prospective controlled trials with long follow‐up are needed to demonstrate definitely the effectiveness, safety and pharmacokinetics of tacrolimus in children with glomerular diseases.

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“…Histologicamente pode ser classificada em vários subtipos. Os tipos histológicos mais comuns em crianças, em ordem decrescente de incidência, são: lesão histológica mínima (LHM) e glomeruloesclerose segmentar e focal (GESF) 1,2 . Na sequência observa-se a nefropatia membranosa e a glomerulonefrite membrano-proliferativa (GNMP), porém, tais entidades são raras em crianças 1 .…”

Section: Síndrome Nefrótica Idiopática -Histologiaunclassified

Avaliação da farmacocinética da ciclosporina em crianças com síndrome nefrótica idiopática

Henriques¹

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Finalmente, serei eternamente grata à minha orientadora, Dra. Maria Helena Vaisbich, pelo reconhecimento, confiança, apoio, respeito, amizade e por todos os seus ensinamentos na minha vida pessoal e profissional. Que esse trabalho tenha sido apenas o início de uma grande e sincera amizade entre nós. NORMALIZAÇÃO ADOTADA Esta dissertação está de acordo com as seguintes normas em vigor no momento desta publicação.

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Management of Nephrotic Syndrome in Children

Cited by 12 publications

References 80 publications

Long-term effects of levamisole treatment in childhood nephrotic syndrome

Long-term effects of levamisole treatment in childhood nephrotic syndrome

Off‐label use of tacrolimus in children with glomerular disease: Effectiveness, safety and pharmacokinetics

Avaliação da farmacocinética da ciclosporina em crianças com síndrome nefrótica idiopática

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