ROLE OF PULSE CYCLOPHOSPHAMIDE IN CHILDREN WITH FREQUENTLY RELAPSING NEPHROTIC SYNDROME (FRNS) AND STEROID DEPENDENT NEPHROTIC SYNDROME (SDNS)

Oral cyclophosphamide (OCP) in the treatment of frequently relapsing (FR) and steroid dependent (SD) idiopathic nephrotic syndrome (INS) poses problems of compliance, sideeffects and infections. Therefore, cyclophosphamide pulses given intravenously may provide an option that maintains remission with less-frequent side effects.Aim- To assess the usefulness of Intravenous Cyclophosphamide (IVCP) in FRNS and SDNS. Method- We retrospectively evaluated the usefulness of IVCP in children with FRNS and SDNS. Thirty children were included in this study of whom 17 were FRNS and 13 were SDNS. IVCP was administered in a dose of 500mgm2month for 6 months after achieving a steroid induced remission. During this period, patients were maintained on low dose oral steroids (5mgday). We retrospectively analyzed patients for compliance with therapy, remission rate, maintenance of remission, occurrence of relapse and side effects during this period and for an additional 6 months after withdrawal of cyclophosphamide. Results- At the end of 6 months treatment period 19 patients (63.3) were in remission. Number of persistent remission at the end of one year was 15 (50). Vomiting was seen in 4 patients (13.2). Two patients (6.6) developed pneumonitis. Leucopenia was seen in 3 patients (9.9) which were transient. No incidence of haemorrhagic cystitis. Notably treatment adherence was 100. No incidence of severe bone marrow depression and alopecia. Conclusion- IVCP has comparable efficacy with oral cyclophosphamide therapy in SDNS and FRNS with less cumulative dose, fewer complications and good adherence.