ALKYLATING AGENT TREATMENT IN CHILDREN WITH STEROID-RESISTANT NEPHROTIC SYNDROME IN WEST JAVA

Authors

  • Ahmedz Widiasta Nephrology division, Child Health Department, Faculty of medicine, Universitas Padjadjaran, Indonesia http://orcid.org/0000-0001-5664-089X
  • Dedi Rachmadi Universitas Padjadjaran, Indonesia
  • Dany Hilmanto Universitas Padjadjaran, Indonesia

DOI:

https://doi.org/10.24269/ijhs.v9i1.8383

Abstract

Objective: to evaluate SRNS therapy in children. Steroid-resistant nephrotic syndrome (SRNS) is one of the most common causes of chronic kidney disease in children. Kidney Disease Initiative for Global Outcome (KDIGO) no longer recommends an alkylating agent (AA) as the treatment protocol for SRNS, still in some developing countries, such as Indonesia, there are some limitations in obtaining immunosuppressive agents other than AA. Method: Data were collected from the medical records of SRNS children with SRNS aged between 1 and 18 years from January 2016 to December 2021. The data included time to remission, adverse effects, and relapse-free period after receiving AA treatment based on the lesion type.  Results: Among the 369 patients enrolled from January 2016 to December 2018, 244 patients (66.12%) had remission with AA, and 125 patients experienced persistent proteinuria. Most of them had remission during the fifth to seventh cycles of intravenous AA (after 6 – 8 months). None of the patients experienced severe adverse effects of AA. Only a small proportion of patients had chronic kidney disease (CKD) stage II–V during follow-up. Conclusions: AA is still effective in treating SRNS in children, with only a few and less harmful adverse effects

Downloads

Download data is not yet available.

Author Biography

Ahmedz Widiasta, Nephrology division, Child Health Department, Faculty of medicine, Universitas Padjadjaran

Pediatric, Nephrology, Genetics, Epigenetic, Preventive medicine

References

[1]. R. Hjorten, Z. Anwar, and K. J. Reidy, “Long-term Outcomes of Childhood Onset Nephrotic Syndrome.,” Front. Pediatr., vol. 4, pp. 53–65, 2016, doi: 10.3389/fped.2016.00053.

[2]. M. H. Varwani and A. Sokwala, “Treatment of steroid-resistant focal segmental glomerulosclerosis with rituximab: A case report and review of literature,” Saudi J. Kidney Dis. Transpl., vol. 28, no. 5, pp. 1175–1179, 2017, doi: 10.4103/1319-2442.215133.

[3]. A. Widiasta, K. Wahyudi, Y. Sribudiani, and D. Rachmadi, “The level of transforming growth factor-β as a possible predictor of cyclophosphamide response in children with steroid-resistant nephrotic syndrome.,” BioMedicine, vol. 11, no. 3, pp. 68–75, 2021, doi: 10.37796/2211-8039.1205.

[4]. R. Hjorten, Z. Anwar, and K. J. Reidy, “Long-term outcomes of childhood onset nephrotic syndrome,” 2016. doi: 10.3389/fped.2016.00053.

[5]. A. WIdiasta, K. Wahyudi, H. Nugrahapraja, Y. Sribudiani, and D. Rachmadi, “The Unique Difference Between Serum Level of Soluble Urokinase Plasminogen Activator Receptor (suPAR) in Steroid-Resistant Nephrotic Syndrome Children Treated with an Alkylating Agent and Calcineurin Inhibitors,” J. Compr. Pediatr., vol. In Press, no. In Press, 2021, doi: 10.5812/compreped.109912.

[6]. B. H. Rovin et al., “KDIGO 2021 Clinical Practice Guideline for the Management of Glomerular Diseases,” Kidney Int., vol. 100, no. 4, pp. S1–S276, 2021, doi: 10.1016/j.kint.2021.05.021.

[7]. M. A. Sepahi, N. Farahani, M. R. Razavi, and H. Heydari, “Rituximab versus cyclophosphamide for the treatment of children with steroid resistance nephrotic syndrome ; a clinical trial study,” vol. 5, no. 2, 2019, doi: 10.15171/ipp.2019.15.

[8]. Y.-C. Li, J. Huang, X. Li, and S.-M. Zhao, “A comparison of cyclophosphamide versus tacrolimus in terms of treatment effect for idiopathic membranous nephropathy: A meta-analysis,” Nefrología, vol. 39, no. 3, pp. 269–276, May 2019, doi: 10.1016/j.nefro.2018.10.008.

[9]. K. A. Mills, R. Chess-Williams, and C. McDermott, “Novel insights into the mechanism of cyclophosphamide-induced bladder toxicity: chloroacetaldehyde’s contribution to urothelial dysfunction in vitro.,” Arch. Toxicol., vol. 93, no. 11, pp. 3291–3303, Nov. 2019, doi: 10.1007/s00204-019-02589-1.

[10]. O. A. Yenigun EC, Turgut D, Piskinpasa S, Ozturk R, Dede F, “Cyclosporine is not inferior to cyclophosphamide in the treatment of idiopathic membranous glomerulonephritis: single centre experience,” Int J Clin Exp Med, vol. 9, no. 1, pp. 316–322, 2016.

Downloads

Additional Files

Published

2025-03-30

Issue

Vol. 9 No. 1 (2025): March

Section

Artikel

Citation Check

License

Authors who publish with Indonesian Journal for Health Sciences (IJHS) agree to the following terms:

1. Copyright and License
The copyright of articles published in the Indonesian Journal for Health Sciences is transferred to and held by the journal/publisher. Authors agree to transfer the copyright of their accepted articles to the Indonesian Journal for Health Sciences. All published articles are distributed under a Creative Commons Attribution-ShareAlike (CC BY-SA) license. This license allows others to share, adapt, and build upon the work in any medium or format, including for commercial purposes, provided that appropriate credit is given to the original source and that any derivative works are distributed under the same license..

2. Author Rights
Authors are permitted and encouraged to share their work online (e.g., in institutional repositories, personal websites, or academic networking platforms) before and during the submission process, as this can lead to productive academic exchanges and increased citation of the published work. Authors may archive the pre-print, post-print, or publisher’s PDF version of their article with an acknowledgment of its initial publication in Indonesian Journal for Health Sciences.

3. Copyright Transfer Agreement
Indonesian Journal for Health Sciences requires authors to complete and sign a formal Copyright Transfer Agreement (CTA) form before publication. The form confirms that the submitted work is original, has not been published elsewhere, and that all authors agree to transfer the publication rights to the journal for the purpose of dissemination and indexing.
The form can be downloaded here

Creative Commons License
This work is licensed under a Creative Commons Attribution-ShareAlike 4.0 International License.