METHYLPREDNISOLONE PULSE THERAPY IN MANAGEMENT OF NON RESPONDER NEPHROTIC SYNDROME

Abstract

Some patients with the diagnosis of childhood nephrotic syndrome are unresponsive to conventional treatment regimens. Recent studies of more aggressive therapies have provided strong evidence of the benefit of high dose methylprednisolonc (MP) protocol with alternate - day prednisone alone or with alternate - day prednisone plus an alkylating agent (I) in these patients.
From May 1996 to May 1997 we have treated 14 patients with non-responder nephrotic syndrome with mcthyprcdnisolone protocol. Eight patients had histologic diagnosis of focal segmental glomerulosclerosis, 3 diffuse mesangial proliferation and 3 has minimal change disease. C'ylosporin was added in two patients to methylprcdnisotonc at the beginning of the second course of therapy. Tfie patients were observed for an average of 8 months (range 4-12 months). In the last follow up there were no patients in remission and all remained nephrotic. Seven patients had persistent massive proteinuria with normal creatinine clearance (CrCI). Two had decreased CrCl. Five progressed to end-stage renal disease. Tlicsc observations suggest that "Puke" methy{prednisolone is not effective in patients with non respondcr nephrotic syndrome.