Cyclosporine Versus Cyclophosphamide in Childhood Nephrotic Syndrome

OBJECTIVE: To determine the response of Cyclosporine versus Cyclophosphamide in childhood nephrotic syndrome.PLACE AND DURATION: Nephrology Unit, National Institute of Child Health, Karachi, from April - September 2012.STUDY DESIGN: Prospective Comparative study.METHODS: 158 patients aged 6 months to 15 years with either steroid resistant (SR) or steroid dependent nephrotic syndrome (SDNS) were randomly assigned to receive either cyclosporine (CS - arm) or cyclophosphamide (CP-arm) for 3 months along with alternate day prednisolone. Treatment response and side effects were monitored clinically and by laboratory tests (spot urine protein-creatinine ratio in both arms, serum creatinine in CS-arm and complete blood counts in CP -arm). Outcome was defined after 12 weeks as complete remission (CR), partial remission and resistance. Data including demographics, type of NS, treatment response and adverse effects were collected and analyzed on SPSS-16.RESULTS: There were 79 patients in each arm. Mean age in both arms was almost identical (6.8 +/- 3.9 and 6.9 +/- 3.7 years). Among 158, 87(55%) were SD and 71(45%) were SRNS. Majority (78.5%) in CS-arm achieved CR compared to 34.2% in CP-arm. This is highly significant (p value < 0.001). Partial remission was observed in 19% of CS -arm compared to 48% in CP-arm and 2.5% were resistant in CS -arm compared to 17.7% in CP -arm. Hypertrichosis (5%), hypertension (3.7 %), gum hyperplasia(3.7%), nephrotoxicity(2.5%) were observed in CS -arm, whereas bone marrow suppression (7.5%), alopecia and infections (2.5% each) were noted in CP-arm.CONCLUSIONS: Cyclosporine was more effective in inducing remission (78.5%) as compared to cyclophosphamide (34.2%) in childhood NS.