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

Ahmedz Widiasta* -  Nephrology division, Child Health Department, Faculty of medicine, Universitas Padjadjaran, Indonesia
Dedi Rachmadi -  Universitas Padjadjaran, Indonesia
Dany Hilmanto -  Universitas Padjadjaran, Indonesia

DOI : 10.24269/ijhs.v9i1.8383

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

Supplement Files

Keywords
Alkylating Agent, Nephrotic Syndrome, Outcome, Steroid-Resistant
  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.

Full Text: Supp. File(s):
Outcome of cyclophosphamide treatment in pediatric steroid resistant nephrotic syndrome in West Java, Indonesia
Subject Outcome, cyclophosphamide, children, steroid resistant nephrotic syndrome
Type Other
  Download (16KB)    Indexing metadata
Outcome of cyclophosphamide treatment in pediatric steroid resistant nephrotic syndrome in West Java, Indonesia
Subject cyclophosphamide, children, steroid resistant nephrotic syndrome
Type Other
  Download (44KB)    Indexing metadata
Article Info
Submitted: 2023-12-06
Published: 2025-03-30
Section: Artikel
Article Statistics: