Korean Journal of Nephrology 1997;16(2):246-253.

스테로이드 의존형 신증후군 환아에서의 세포독성약제 ( cyclophosphamide, chlormucil ) cyclosporine 및 lecamisole의 치료효과

임현석 , 노은석 , 최병호 , 고철우 , 구자훈

Abstract

Prolonged administration of steroid in children with steroid-dependent nephrotic syndmme can cause seri- ous complications including growth failure, and various altemative treatments have been used for these children to alleviate steroid-induced complications and to achieve long-lasting remission. Present study was undertaken to compare the th- erapeutic efficacy of cytotoxic agents (cyclophospha- mide & chlorambucil), cyclosporine and levamisole in 88 children with steroiddependent mininal-change nephrotic syndrome, who have been followed-up in Pediatric Department, Kyungpook National University Hospital from 1985 to 1995. Cyclophosphamide and chlorambucil were given for 8 weeks (cyclophosphamide in 36 and chlorambucil in 13 cases) or 12 weeks (cyclophosphamide in 34 and chlorambucil in 12 cases), and cyclosporine (3-Smg/kg/day) and lev amisole (2-2.5mg/kg alternate day) were given for 6-12 months. And the results were as follows ; Results of cytotoxic therapy ; At the end of the 1st year, remission rate with 12 wks course of cyclophosphamide(53%) was better than with 12 wks course of chlorambucil(33%) or 8 wks course of either drugs. However, at the end of the 2nd year, no difference was noted in remission rate between 12 wk course of cyclophosphamide(19%) and chlorambucil(17%). Results of cyclosporine therapy ; Out of 44 cases, 28(64%) showed sustained remission, 8(18%) relapse with decreased frequency and steroidsparing effect, and 8 no therapeutic effects. During treatment period, BUN, creatinine and blood pressure were remained in normal ranges. Remission rates with cyclosporine alone therapy without steroid in cyclos- porine-responsive children were 83%, 83%, 57% and 43% at 2, 4, 6 and 8 months, respectively. Results of levamisole therapy ;, Out of 16 cases, 8 (50%) showed sustained remission, 5(31%) relapse w!th decreased frequency and steroid-sparing effect, and 3 no therapeutic effects. In one case, transient neutropenia was observed without serious sequelae. Remission rate with levamisole alone therapy without steroid in levamisole-responsive children were 88%, 85%, 67% and 44% at 2, 4, 6 and 8 months, respectively. In conclusion, present study indicates that 12 weeks course of cyclohosphamide or chlorambucil seems to be the most effective therapy for inducing longlasting remission in steroid-dependent nephrotic children. And long-term use of cyclosporine or leva misole can also be used quite effectively in achieving prolonged remission and steroidsparing effects without serious side effects.