RESEARCH ARTICLE


Clinical Course of Steroid Sensitive Nephrotic Syndrome in Children: Outcome and Outlook



Svitlana Fomina1, *, Tatjana Pavlenko2, *, Erling Englund3, Ingretta Bagdasarova1
1 Department of Pediatrics, State Institution “Institute of Nephrology of the Academy of Medical Science of Ukraine”, Kyiv, Ukraine
2 Department of Mathematics, Royal Institute of Technology, SE-100 44 Stockholm, Sweden
3 Västernorrland County Council, Research and Development Centre, Sundsvall, Sweden

Article Information


Identifiers and Pagination:

Year: 2011
Volume: 5
First Page: 18
Last Page: 28
Publisher Id: TOPEDJ-5-18
DOI: 10.2174/1874309901105010018

Article History:

Received Date: 12/04/2011
Revision Received Date: 21/06/2011
Acceptance Date: 21/07/2011
Electronic publication date: 14/10/2011
Collection year: 2011

© 20011 Fomina et al.

open-access license: This is an open access article distributed under the terms of the Creative Commons Attribution 4.0 International Public License (CC-BY 4.0), a copy of which is available at: https://creativecommons.org/licenses/by/4.0/legalcode. This license permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

* Address correspondence to this author at the State Institution ”Institute of Nephrology of the Academy of Medical Science of Ukraine“, Department of Pediatrics, 17b Degtyarivska str, Kiev, Ukraine; Tel: int +46-8 790 8466, Fax: int+46-8 723 1788; E-mail: sfomina@meta.ua Department of Mathematics, Royal Institute of Technology, SE-100 44 Stockholm, Sweden; E-mail: Email: pavlenko@math.kth.se


Abstract

Introduction:

The aim of our study was to investigate the relative efficiency and adverse effects of various treatments of steroid sensitive nephrotic syndrome (SSNS) in children, and to determine factors associated with relapse risk in these patients.

Materials and Method:

We retrospectively studied the data from 690 SSNS children treated in referral center over 25 years. The analyzed treatment protocols were: Prednisolone (PRED, eight weeks in a dose 1.5-2.0 mg/kg, then it tapering and given for 9-12 months), Chlorambucil (CHL, cumulative dose 28.5-30 mg/kg), Cyclophosphamide intravenously (CYC I.V., cumulative dose of 30-36 mg/kg, then supporting dose of CHL, cumulative dose of 20-25 mg/kg) and intramuscular (CYC I.M., cumulative dose of 120-150 mg/kg). The alkylating agents were used after remission induction by PRED and under its protection.

Results:

Cumulative relapse-free survival was 81.9%, 69.0% and 64.5% after 12, 36 and 60 months, respectively. In multivariate analyses, relapse risk was associated with age of treatment (<6 years), and both PRED and CYC I.V. The only predictive factor for early relapse was PRED, unlike two and more relapses group where PRED and CYC I.V. as well as age from 3 to 6 years was highly prognostic. The high probability of sustained remission in combination with relatively mild adverse effects was observed for PRED used at first episode and CHL used at relapse.

Conclusion:

To summarize, our protocols characterized by the prolonged PRED and CHL demonstrated promising results and should be considered as an efficient alternative strategy in SSNS management.

Keywords: Nephrotic syndrome , steroid sensitive, cyclophosphamide, chlorambucil , relapse intensity , relapse-free survival, predictive factors.