[Treatment of corticoid-resistant nephrotic syndrome: a still unresolved problem]

Abstract

The nephrotic syndrome persists unchanged after the initial course of steroid therapy in 15 to 20% of patients. In such cases, the severity of the condition lies essentially in the risk of developing end-stage renal failure. This occurs in one third to one half of the cases. Furthermore, some of these children are at risk for recurrence of their original disease in the transplanted kidney. The course of steroid resistant nephrotic syndrome (SRNS) is usually punctuated by the need for numerous hospitalizations for mobilization of edema and treatment of infection. The treatment of patients with SRNS presents a major problem in the field of pediatric nephrology. Immunosuppressive agents may be efficient in some of steroid-resistant patients, inducing remission of proteinuria and protecting renal function. Unfortunately, all these agents have a low therapeutic index. Thus, in deciding whether, how, and when to use immunomodulating drugs, the nephrologist should be aware of their potential side effects, of the results that may be obtained and of the possible strategies for maximizing their therapeutic index.