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Reading: Intravenous pulsed vs oral cyclophosphamide therapy in steroid dependent nephrotic syndrome

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Intravenous pulsed vs oral cyclophosphamide therapy in steroid dependent nephrotic syndrome

Authors:

S Abeyagunawardena,

Teaching Hospital Peradeniya, Sri Lanka, LK
About S
Teaching Hospital Peradeniya, Sri Lanka
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A H H M Jayaweera,

Faculty of Medicine, University of Peradeniya, Sri Lanka, LK
About A H H M
Faculty of Medicine, University of Peradeniya, Sri Lanka 
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R S Thalgahagoda,

Faculty of Medicine, University of Peradeniya, Sri Lanka, LK
About R S
Faculty of Medicine, University of Peradeniya, Sri Lanka
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U I Karunadasa,

Faculty of Medicine, University of Peradeniya, Sri Lanka, LK
About U I
Faculty of Medicine, University of Peradeniya, Sri Lanka
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A S Abeyagunawardena

Faculty of Medicine, University of Peradeniya, Sri Lanka, LK
About A S
Faculty of Medicine, University of Peradeniya, Sri Lanka
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Abstract

Background: No consensus exists concerning dose and route of administration of cyclophosphamide (CYC) in steroid-dependant nephrotic syndrome (SDNS).

Objective: To compare the outcome of children with SDNS treated with either intravenous (IV) or oral CYC in a single centre in Sri Lanka by reviewing data from 2002 to 2011.

Method:  One hundred and twenty seven children with SDNS with evidence of steroid toxicity received either oral or IV cyclophosphamide. Seventy two received IV cyclophosphamide in a dose of 500 mg/m2 monthly for 6 months, and 55 received oral CYC in a dose of 3 mg/kg per day for 8 weeks. In both groups prednisolone was tapered over 6 months in a similar manner. Full blood counts were done weekly during oral treatment and monthly during IV treatment. Patient progress was assessed on a monthly basis for the first year and at 3 monthly intervals thereafter till 5 years.

Results: In the oral CYC group, 4 patients developed bone marrow suppression, 7 had serious infections, 15 had significant alopecia and one child died due to overwhelming sepsis. In the IV group alopecia was seen in 9 patients and one had a serious infection while bone marrow suppression was not seen. At one and 5 year follow ups there was no significant difference in the proportion who suffered a relapse in the 2 groups (p >0.05)

Conclusion: In SDNS, IV cyclophosphamide was as effective as oral CYC in inducing sustained remission and had less side effects and a smaller total dose. 

Sri Lanka Journal of Child Health, 2017; 46(4): 317-321

How to Cite: Abeyagunawardena, S. et al., (2017). Intravenous pulsed vs oral cyclophosphamide therapy in steroid dependent nephrotic syndrome. Sri Lanka Journal of Child Health. 46(4), pp.317–321. DOI: http://doi.org/10.4038/sljch.v46i4.8377
Published on 01 Dec 2017.
Peer Reviewed

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