Efficacy of tacrolimus in steroid dependent and steroid resistant childhood nephrotic syndrome - A retrospective study

There is a paucity of information on outpatient management and risk factors for hospitalization and complications in childhood nephrotic syndrome (NS). We described the management, patient adherence, and inpatient and outpatient usage of 87 pediatric NS patients diagnosed between 2006 and 2012 in the Atlanta Metropolitan Statistical Area. Multivariable analyses were performed to examine the associations between patient characteristics and disease outcome. We found that 51% of the patients were treated with two or more immunosuppressants. Approximately half of the patients were noted to be nonadherent to medications and urine protein monitoring. The majority (71%) of patients were hospitalized at least once, with a median rate of 0.5 hospitalizations per patient year. Mean hospital length of stay was 4.0 (3.8) days. Fourteen percent of patients experienced at least one serious disease complication. Black race, frequently relapsing/steroid-dependent and steroid-resistant disease, and the first year following diagnosis were associated with higher hospitalization rates. The presence of comorbidities was associated with longer hospital length of stay and increased risk of serious disease complications. Our results highlight the high morbidity and burden of NS and point to particular patient subgroups that may be at increased risk for poor outcome.

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Experience with second line drugs in frequently relapsing and steroid dependent childhood nephrotic syndrome in a large Saudi center

International Journal of Pediatrics and Adolescent Medicine ◽

10.1016/j.ijpam.2017.03.002 ◽

2017 ◽

Vol 4 (2) ◽

pp. 66-70 ◽

Cited By ~ 2

Author(s):

Khalid Alsaran ◽

Khalid Mirza ◽

Abdulhadi Al-Talhi ◽

Esam Al-Kanani

Keyword(s):

Nephrotic Syndrome ◽

Second Line ◽

Childhood Nephrotic Syndrome ◽

Steroid Dependent

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Tacrolimus in steroid-resistant and steroid-dependent nephrotic syndrome

Clinical Nephrology ◽

10.5414/cnp65393 ◽

2006 ◽

Vol 65 (06) ◽

pp. 393-396 ◽

Cited By ~ 32

Author(s):

T.H. Westhoff ◽

S. Schmidt ◽

W. Zidek ◽

J. Beige ◽

M. van der Giet

Keyword(s):

Nephrotic Syndrome ◽

Steroid Resistant ◽

Steroid Dependent ◽

Steroid Dependent Nephrotic Syndrome

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Mycophenolate mofetil therapy in frequently relapsing steroid-dependent and steroid-resistant nephrotic syndrome of childhood: current status and future directions

Pediatric Nephrology ◽

10.1007/s00467-005-1964-z ◽

2005 ◽

Vol 20 (10) ◽

pp. 1376-1381 ◽

Cited By ~ 46

Author(s):

Asha Moudgil ◽

Arvind Bagga ◽

Stanley C. Jordan

Keyword(s):

Nephrotic Syndrome ◽

Mycophenolate Mofetil ◽

Current Status ◽

Future Directions ◽

Steroid Resistant ◽

Steroid Resistant Nephrotic Syndrome ◽

Steroid Dependent

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POS-448 CORTICOSTEROID SPARING AGENTS IN FREQUENT RELAPSING AND STEROID DEPENDENT NEPHROTIC SYNDROME IN CHILDREN: A SINGLE CENTER RETROSPECTIVE STUDY

Kidney International Reports ◽

10.1016/j.ekir.2021.03.474 ◽

2021 ◽

Vol 6 (4) ◽

pp. S194-S195

Author(s):

B. ALABBASI ◽

M. Aloufi

Keyword(s):

Nephrotic Syndrome ◽

Retrospective Study ◽

Single Center ◽

Steroid Dependent ◽

Steroid Dependent Nephrotic Syndrome

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Prediction of steroid resistance and steroid dependence in nephrotic syndrome children

Journal of Translational Medicine ◽

10.1186/s12967-021-02790-w ◽

2021 ◽

Vol 19 (1) ◽

Author(s):

Katarzyna Zaorska ◽

Piotr Zawierucha ◽

Monika Świerczewska ◽

Danuta Ostalska-Nowicka ◽

Jacek Zachwieja ◽

...

Keyword(s):

Nephrotic Syndrome ◽

Multiple Logistic Regression Analysis ◽

Kidney Injury ◽

Steroid Resistance ◽

Neural Network Approach ◽

Steroid Resistant ◽

Steroid Dependence ◽

Steroid Dependent ◽

Stage Renal Disease ◽

End Stage

Abstract Background Steroid resistant (SR) nephrotic syndrome (NS) affects up to 30% of children and is responsible for fast progression to end stage renal disease. Currently there is no early prognostic marker of SR and studied candidate variants and parameters differ highly between distinct ethnic cohorts. Methods Here, we analyzed 11polymorphic variants, 6 mutations, SOCS3 promoter methylation and biochemical parameters as prognostic markers in a group of 124 Polish NS children (53 steroid resistant, 71 steroid sensitive including 31 steroid dependent) and 55 controls. We used single marker and multiple logistic regression analysis, accompanied by prediction modeling using neural network approach. Results We achieved 92% (AUC = 0.778) SR prediction for binomial and 63% for multinomial calculations, with the strongest predictors ABCB1 rs1922240, rs1045642 and rs2235048, CD73 rs9444348 and rs4431401, serum creatinine and unmethylated SOCS3 promoter region. Next, we achieved 80% (AUC = 0.720) in binomial and 63% in multinomial prediction of SD, with the strongest predictors ABCB1 rs1045642 and rs2235048. Haplotype analysis revealed CD73_AG to be associated with SR while ABCB1_AGT was associated with SR, SD and membranoproliferative pattern of kidney injury regardless the steroid response. Conclusions We achieved prediction of steroid resistance and, as a novelty, steroid dependence, based on early markers in NS children. Such predictions, prior to drug administration, could facilitate decision on a proper treatment and avoid diverse effects of high steroid doses.

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Relative safety of steroid sparing agents in frequently relapsing, steroid dependent and steroid resistant nephrotic syndrome in pediatric patients

International Journal of Contemporary Pediatrics ◽

10.18203/2349-3291.ijcp20203172 ◽

2020 ◽

Vol 7 (8) ◽

pp. 1762

Author(s):

Sabnam Ara Begum ◽

Santanu Kumar Tripathi ◽

Mousumi Nandy ◽

Sanat Kumar Ghosh ◽

Shatavisa Mukherjee ◽

...

Keyword(s):

Nephrotic Syndrome ◽

Adverse Events ◽

Tertiary Care ◽

Serious Adverse Events ◽

Steroid Resistant ◽

Steroid Resistant Nephrotic Syndrome ◽

Steroid Dependent ◽

Relative Safety ◽

Tertiary Care Hospitals ◽

Steroid Sparing

Background: In patients with frequently relapsing nephrotic syndrome (FRNS), steroid-dependent nephrotic syndrome (SDNS) and steroid resistant nephrotic syndrome (SRNS) steroids are either used for prolonged period of time or ineffective. To reduce the degree of steroid dependency and avoid steroid toxicity, several immunosuppressive steroid sparing agents (SPAs) have been proposed to treat these children. The present study tried to study the relative safety of most commonly steroid sparing agent in such children.Methods: A multi-centred, prospective observational study was conducted in paediatric nephrology OPD of two tertiary care hospitals in Kolkata over a period of 24 months. All consecutive children with diagnosed FRNS, SDNS and SRNS who were started on steroid sparing agents were enrolled and followed up for at least 6 months. Records of clinical examination, laboratory tests were collected and measured at the baseline and regular intervals. Safety parameters were noted and statistically analysed.Results: A total 110 patients were screened, examined and enrolled. Levamisole, cyclophosphamide and MMF were commonly used SPAs. Of the two tertiary care hospitals, all the patients of FRNS and SDNS were started with levamisole and SRNS with cyclophosphamide in one set-up, while in the other hospital some SDNS patients were started with cyclophosphamide and SRNS with MMF but without clinically significant outcomes. In comparison with few minor adverse events in MMF group, some serious adverse events were documented in the both cyclophosphamide and levamisole groups.Conclusions: Levamisole being a very efficacious, safe and easily affordable drug, should be used as an initial first line SPA in treating FRNS and SDNS children. The side effect profiles of levamisole and MMF are much more patient friendly.

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