Pulse cyclophosphamide therapy in frequently relapsing nephrotic syndrome

Background. The treatment of frequently relapsing (FR) and steroid-dependen t (SD) idiopathic nephrotic syndrome (INS) with oral cyclophosphamide (OCP) poses problems of compliance, side-effects and infections. Methods. We prospectively evaluated the usefulness of intravenous cyclophos phamide (IVCP) in children with steroid sensitive INS who were frequent rel apsers or steroid dependent. Fifty-one children were included in the study of whom 22 were FR and 29 were SD. IVCP was administered in a dose of 500 m g/m(2)/month for 6 months after achieving a steroid-induced remission. The response to IVCP was evaluated in terms of remission, change in the steroid response status of the patient, duration of remission (i.e. protein uria-f ree days), side effects and compliance with therapy. Results. The proteinuria- free days (mean 19.9 +/- 3.5 before IVCP therapy vs 1256 +/- 167 days after IVCP therapy) (P <0.00001), and serum albumin le vels (23 +/- 1.6 g/l before IVCP therapy vs 34 +/- 2 g/l after IVCP therapy ) (P <0.001) were significantly higher following IVCP therapy. The cumulati ve remission rate in the study group was 49% at 5 years and was comparable to that achieved with oral cyclophosphamide at a 40% lower cumulative dose. Conclusions. We conclude that IVCP is a safe and effective therapeutic moda lity in children with INS who are FR and SD. Its efficacy is comparable to the results obtained with oral cyclophosphamide based on historical compari sons with previous studies.