Duration of remission of steroid-dependent nephrotic syndrome after cyclosporin and mycophenolate sodium therapy in children with and without clinical manifestation of allergy

Abstract

BACKGROUND. The problem of steroid-sensitive nephrotic syndrome is the developing of steroid dependency and toxicity.THE AIM: Evaluate duration of remission of steroid-dependent nephrotic syndrome (NS) after cyclosporine and mycophenolate sodium therapy in children with or without clinical manifestation of allergy.PATIENTS AND METHODS. Follow-up study with analysis of onset, clinical course and treatment includes 47 children ((31 boys (66 %) и 16 girls (34 %)) with steroid-dependent NS, 34 (72,3 %) had clinical manifestation of allergy, 13 (27,7 %) didn’t have clinical manifestation of allergy. The efficiency of therapy with cyclosporine in 16 patients and mycophenolate sodium in 27 patients with clinical manifestation of allergy is estimated in comparative study by analysis of 6, 12, 24 month remission rate after treatment. Median duration of remission of NS during 2 years after treatment is estimated. Out of 27 children 8 (29,6 %) had mycophenolate sodium treatment after cyclosporine and took part in both groups.RESULTS. Statistically significant differences in 6, 12, 24 month remission rates after cyclosporine and mycophenolate sodium treatment in children with clinical manifestation of allergy are established. Remission of NS during 6 months after mycophenolate sodium treatment was in 81,5 % (in 22 from 27 patients) unlike of that after cyclosporine – in 40 % (in 6 from 15 patients) in children with clinical manifestation of allergy (р<0,05). Remission of NS during 12 months after mycophenolate sodium treatment was in 55,6  % (in 15 from 27 patients) unlike of that after cyclosporine – 13,3 % (in 2 from 15 patients) (р<0,05) in children with clinical manifestation of allergy. Remission of NS during 24 months after mycophenolate sodium treatment was in 37 % (in 10 from 27 patients) unlike of that after cyclosporine – 6,7 % (in 1 from 15 patients) (р<0,05) in children with clinical manifestation of allergy. Median duration of remission during 2 years after treatment with cyclosporine and mycophenolate sodium in children with clinical manifestation of allergy was 7,0 [2,0-11,0] and 17,0 [6,0-24,0] months, retrospectively, (р<0,05).CONCLUSION. Remission of steroid-dependent NS during 6 months after therapy with mycophenolate sodium and cyclosporine in children was in 81,5 % and 40,0 % respectively, in children with clinical manifestation of allergy. Remission of steroid-dependent NS during 12 months after therapy with mycophenolate sodium and cyclosporine in children was in 55,6 % and 13,3 % respectively, in children with clinical manifestation of allergy. Remission of steroid-dependent NS during 24 months after therapy with mycophenolate sodium and cyclosporine in children was in 37 % and 6,7 % respectively, in children with clinical manifestation of allergy. Median duration of remission during 2 years after treatment with cyclosporine and mycophenolate sodium in children with clinical manifestation of allergy was 7,0 [2,0-11,0] and 17,0 [6,0-24,0] months, retrospectively. As the result of comparative study duration of remission of steroid-dependent NS in children with clinical manifestation of allergy was statistically significantly longer in children after therapy with mycophenolate sodium.