Pharmacotherapeutic review and update of idiopathic nephrotic syndrome in children

Manrique-Rodríguez, Silvia; Fernández-Llamazares, Cecilia M.; Sanjurjo‐Sáez, María

doi:10.1007/s11096-010-9380-2

Cited by 11 publications

(12 citation statements)

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“…Interestingly, a recent survey to assess management of childhood-onset NS among 30 American pediatric nephrologists from ten institutions showed that 48% of respondents preferred alkylating agents and 37% calcineurin inhibitors for SDNS [37]. However, MMF was proposed as a possible alternative to anticalcineurins for second-line (after steroids) therapy of SDNS by the Children's Nephrotic Syndrome Consensus Conference in 2009 [38] and by Manrique-Rodriguez et al in 2010 [39]. Our report strongly supports the proposal that MMF be given before calcineurin inhibitors, considering its efficiency and its lack of nephrotoxicity and cosmetic effects.…”

Section: Discussionmentioning

confidence: 99%

“…Interestingly, mizoribine, a purine-metabolism inhibitor that mimics MMF, has been shown to induce a significant reduction of prednisolone dose and relapse rate in nine of ten children with SDNS who had received neither cyclophosphamide nor cyclosporine previously [42]. Therefore, cyclophosphamide, because of its adverse effects and relatively low efficacy in SDNS [34][35][36], should now rather be positioned after MMF and cyclosporine, as proposed [38,39].…”

Section: Discussionmentioning

confidence: 99%

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Mycophenolate mofetil for steroid-dependent nephrotic syndrome: a phase II Bayesian trial

et al. 2011

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Mycophenolate mofetil (MMF) has emerged as a new therapeutic option in steroid-dependent nephrotic syndrome (SDNS). We conducted a phase II Bayesian trial of MMF in children with SDNS. Phase II trials, usually single-arm studies, investigate the effect of new treatments. Standard Fleming's procedure relies on observed results (relapse rate during the trial), whereas Bayesian approach combines observed results with prior information (expected relapse rate according to prior studies and clinical experience). All patients were required to have received prior alkylating-agent treatment. Sixty-seven percent of them had also received levamisole. Patients received MMF (1,200 mg/m(2)/day) and prednisone according to a defined schedule [reduction of alternate-day (e.o.d) dose to 50% of pre-MMF dose at 3 months, 25% at 6 months]. Twenty-four children (median age 6.0 years, 2.8-14.4) entered the study and 23 completed it. Bayesian analysis showed that adding four patients would not change significance of results, allowing stopping inclusions. Four patients relapsed during the first 6 months (estimated probability 17.6%, 95% credibility interval: 5.4-35.0%) and two at months 8 and 11.5. In the 19 patients free of relapse during the first 6 months, median (Q1-Q3) prednisone maintenance dose decreased from 25 (10-44) to 9 (7.5-11.2) mg/m(2) e.o.d (p < 0.001) and cumulative dose from 459 (382-689) to 264 (196-306) mg/m(2)/month (p < 0.001) before and on MMF respectively. Pre-MMF patient characteristics and MMF pharmacokinetics did not differ between patients with or without relapse. MMF reduces relapse rate and steroid dose in children with SDNS and should be proposed before cyclosporine and cyclophosphamide.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Mycophenolate mofetil for steroid-dependent nephrotic syndrome: a phase II Bayesian trial

et al. 2011

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“…[4,22]. Ad a, vomit, anorexia, abdominal distention, reduction of leukocyte, liver dysfunction and influences on menstrual cycle of female patients of childbearing age [9,12,17].…”

Section: Discussionmentioning

confidence: 99%

The Clinical Efficacy of Low-Dose Tacrolimus Combined with Tripterygium to Treat the Steroid-Resistant Nephrotic Syndrome

Ren¹,

Chen²,

Zhou³

et al. 2012

OJNeph

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Objective: To observe the clinical efficacy and safety of low dose tacrolimus (TAC) combined with tripterygium (TW) in treatment of steroid resistant nephritic syndrome (SRNS). Method: The patients, who were diagnosed with mesangial proliferative glomerulonephritis (MesPGN) and focal segmental glomerulosclerosis (FSGS) by biopsy and failed to respond to a 3-month treatment with prednisone (1 mg/kg·d), were randomly divided into 2 groups (TAC + TW Group and TW Group). Initially TAC + TW group took TAC 0.05mg/(kg·d) 2 h after meal at 12 h interval. The plasma TAC level was examined after 3 days and was kept at 1.5 -4 ng·ml; meanwhile, TW was given at 60 mg/d before meal. TW group only took TW (60 mg/d). The efficacy, adverse reactions and plasma TAC levels were observed in each group. Results: 1) Totally 20 SRNS patients completed the trial, 11 of TAC + TW Group and 9 of TW Group. There is no statistical difference between the two groups in terms of age, gender, duration since onset of the disease, blood pressure, 24 h UPQ, serum albumin, creatinine, cholesterol, triglyceride, FBG, kidney pathological categories, time of taking prednisone etc.; 2) Urine protein started to decrease after 1 month treatment in both of TAC + TW and TW groups. By the 12th month of treatment, TAC + TW group showed 8 cases of complete remission (72.7%), 2 cases of partial remission (18.2%) and 1 case of no improvement (9.1%), while those of TW groups were 2 (22.2%), 4 (44.5%) and 3 (33.3%), respectively; 3) With treatment, the TAC + TW Group patients' plasma protein was significantly higher than that of pretreatment stage and recovered to normal level after 6 month of treatment. However, there was no significant plasma protein increase in TW Group. No obvious changes were observed on serum creatinine level of patients of both the two groups; 4) The incidence of adverse reactions was not significantly different between the two groups. Conclusion: TAC + TW reduced proteinuria of SRNS patients, increased clinical remission rate and was tolerant to SRNS patients. We conclude that TAC + TW treatment is an effective way to treat patients with SRNS.

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“…Steroid dirençli hastalarda; kullanılabilen başlıca diğer immünsüpresif ilaçlar; alkilleyici ilaç grubu, örneğin; siklofosfamid, klorambusil, kalsinörin inhibitörleri (CNIs), siklosporin and takrolimus, mikofenolat mofetil (MMF), rituksimab ve adrenokortikotropik hormon (ACTH) olarak sıralanabilir. 17 Steroid dirençli hastalarda alkilleyici ilaçlar tedaviye eklenebilmektedir. Alkilleyici tedaviler; genellikle nefrotik düzeyde proteinüri varlığında böbrek fonksiyonları normal ve normale yakın ise tercih edilmektedir.…”

Section: İdi̇yopati̇k Nefroti̇k Sendrom Tedavi̇si̇nde İmmünopatogenezi̇n Etunclassified

The Effects of Idiopathic Nephrotic Syndrome Immunopathogenesis on the Therapeutic Approaches: Review

Akalın¹,

Köroğlu²

2016

Turkiye Klinikleri J Intern Med

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Pharmacotherapeutic review and update of idiopathic nephrotic syndrome in children

Cited by 11 publications

References 50 publications

Mycophenolate mofetil for steroid-dependent nephrotic syndrome: a phase II Bayesian trial

Mycophenolate mofetil for steroid-dependent nephrotic syndrome: a phase II Bayesian trial

The Clinical Efficacy of Low-Dose Tacrolimus Combined with Tripterygium to Treat the Steroid-Resistant Nephrotic Syndrome

The Effects of Idiopathic Nephrotic Syndrome Immunopathogenesis on the Therapeutic Approaches: Review

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