Sign-in to Ask A Doctor - 24x7
OR
Sign in with Google
What Causes Frequent Relapses In A Patient With Nephrotic Syndrome?
Question: Good evening Sir, My 15 year old boy suffering from NS since 2007. He is steroid responsive and on Omnacortil 5 mg as maintain dose. It relapsed infrequently up to last year. His creatinine is between 0.5 to 0.8 XXXXXXX through out the period. A/G ratio is over 1.3 and blood albumin is 4.0 to 6.1 after periodical tests. During relaps the urine protein varies from 2000 to 12000+ for first 5 to 6 days. As soon as NS relap from very second day he is treated by omnacortil 20 to 40 mg. and NS is under control by 3 to 6 days. Normally we found that most of the time of NS relap he was suffering from cold/cough and little bit of stress. Now I think he is steroid dependent and I want make him steroid free. How can I ? Note that he is treated from XXXXXXX hospital XXXXXXX XXXXXXX Kidney foundation XXXXXXX Kidney hospital Nadiad, Livati and Hinduja hospital XXXXXXX
Brief Answer:
Steroid sparing agents are the treatment of choice at this stage
Detailed Answer:
Hello, Sir/Madam.
I understand your concern.
Frequent relapses are a part and parcel of NS.Relapses are common in presence of stress factors, both internal as well as environmental.
This is a clear cut case of FRNS(frequently relapsing nephrotic syndrome) and SDNS(Steroid dependent nephrotic syndrome).
Therefore, in FRNS and SDNS, the general practice is to change therapy to a steroid-sparing agent once remission of proteinuria has been achieved.
The current KDIGO(kidney disease improving global outcomes) 2012 guidelines recommend that in FRNS and SDNS, prednisone(OMNACORTIL) treatment be prescribed a (60 mg/d) as a single morning dose until the patient has been free of proteinuria for at least 3 days.
Following remission of proteinuria, prednisone is reduced to (40 mg/d) given as a single dose on alternate days and tapered over 3 or more months. A steroid-sparing agent can be considered once proteinuria is in remission.
Commonly recommended steroid sparing agents are Cyclophosphamide/CYP(better efficacy) and Mycophenolate Mofetil/MMF(better safety).
Please check with your physician if he shares my view and if can prescribed these drugs and apply these guidelines to your child.
This is the best way to get rid of steroids at this stage of the disease.
Cyclophosphamide has been successfully used in conditions that require immunosuppression. It is highly effective for frequently relapsing steroid-sensitive nephrotic syndrome; half of the children enter a prolonged remission. The usual duration of drug therapy is for 12 weeks.
MMF might be a useful steroid-sparing agent in stable patients (without excessive edema, need for hospitalizations and without other serious complications) whose families wish to avoid the possible side effects of CYP. However, response to MMF varies and is less reliable than other treatments.
Side effects exist for 2 drugs ,but are more common with CYP.
Post your further queries if any.
Thank you.
Steroid sparing agents are the treatment of choice at this stage
Detailed Answer:
Hello, Sir/Madam.
I understand your concern.
Frequent relapses are a part and parcel of NS.Relapses are common in presence of stress factors, both internal as well as environmental.
This is a clear cut case of FRNS(frequently relapsing nephrotic syndrome) and SDNS(Steroid dependent nephrotic syndrome).
Therefore, in FRNS and SDNS, the general practice is to change therapy to a steroid-sparing agent once remission of proteinuria has been achieved.
The current KDIGO(kidney disease improving global outcomes) 2012 guidelines recommend that in FRNS and SDNS, prednisone(OMNACORTIL) treatment be prescribed a (60 mg/d) as a single morning dose until the patient has been free of proteinuria for at least 3 days.
Following remission of proteinuria, prednisone is reduced to (40 mg/d) given as a single dose on alternate days and tapered over 3 or more months. A steroid-sparing agent can be considered once proteinuria is in remission.
Commonly recommended steroid sparing agents are Cyclophosphamide/CYP(better efficacy) and Mycophenolate Mofetil/MMF(better safety).
Please check with your physician if he shares my view and if can prescribed these drugs and apply these guidelines to your child.
This is the best way to get rid of steroids at this stage of the disease.
Cyclophosphamide has been successfully used in conditions that require immunosuppression. It is highly effective for frequently relapsing steroid-sensitive nephrotic syndrome; half of the children enter a prolonged remission. The usual duration of drug therapy is for 12 weeks.
MMF might be a useful steroid-sparing agent in stable patients (without excessive edema, need for hospitalizations and without other serious complications) whose families wish to avoid the possible side effects of CYP. However, response to MMF varies and is less reliable than other treatments.
Side effects exist for 2 drugs ,but are more common with CYP.
Post your further queries if any.
Thank you.
Note: For further queries related to kidney problems and comprehensive renal care, talk to a Nephrologist. Click here to Book a Consultation.
Above answer was peer-reviewed by :
Dr. Raju A.T
Answered by
Get personalised answers from verified doctor in minutes across 80+ specialties
