Original article
A controlled prospective study of cyclophosphamide in relapsing, corticosteroid-responsive, minimal-lesion nephrotic syndrome in childhood1

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This prospective controlled study was designed to investigate whether cyclophosphamide reduces the recurrence rate in relapsing, corticosteroid-responsive, minimal-lesion nephrotic syndrome (MLNS) in childhood. Patients were treated with either prednisone alone (Group 1) or prednisone and cyclophosphamide (Group 2) for four months. Duration of follow-up was 25 months. Relapse icidence was 90.9 per cent in Group 1 and 16.7 per cent in Group 2 (p<0.01). There was no correlation between the therapeutic effect of cyclophosphamide and leukopenia. The study conclusively demonstrates the beneficial effect of cyclophosphamide in prolonging remission time and reducing the relapse rate in MLNS. In view of potentially serious side effects on reproductive function, cyclophosphamide should be used in relapsing MLNS only when corticosteroids alone do not provide satisfactory control.

References (24)

  • CameronJ.S. et al.

    Sterility and cyclophosphamide

    Lancet

    (1972)
  • van AckerK.J. et al.

    The influence of hormone treatment on the natural evolution of the idiopathic nephrotic syndrome in childhood

    Acta Paediatr. Scand.

    (1968)

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    1

    Aided by Term Grant MT-1579 from the Medical Research Council of Canada

    Presented in part at the Fourth annual meeting of the American Society of Nephrology, Washington, D. C., November 22 and 23, 1971.

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    Copyright © 1973 Published by Mosby, Inc.