Treatment of children with steroid refractory idiopathic nephrotic syndrome: The Kuwaiti experience

Data on the treatment and outcome of Kuwaiti children with steroid refracto ry idiopathic glomerulonephritis (SRIGN), i.e. nephrotic syndrome who faile d an eight-week course of prednisone, were collected retrospectively from t he records of children attending the two renal centers of Kuwait between Ja nuary 1, 1990 to December 31, 1996. During those seven years, a total of 34 Kuwaiti children were diagnosed to have SRIGN. Histologically, 22 (65%) of those patients had minimal change, 5 (15%) focal segmental GN, 2 (6%) non- IgA mesangioproliferative GN and one membranous GN. Twenty-two patients had manifested frequent relapses, six were steroid-dependent and six were ster oid-resistant. Treatment options were in the following order: (a) small mai ntenance-dose of corticosteroids (< 0.5 mg/kg/alternate nays); (b) cyclopho sphamide and or chlorambucil for a single eight week-course or eight then 1 2 week courses (c) cyclosporin Lambda for three months. The response to the rapy was as follows. nine children were cured with low-dose corticosteroids ; 17 with chlorambucil and/or cyclophosphamide; and five with cyclosporin L ambda. At the end of study, only three children failed such drug therapy, t wo of who had focal segmental glomeruloscierosis.