JLE

Médecine thérapeutique / Pédiatrie

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Use of immunosuppressive agents for steroid-dependant nephrotic syndrome in children Volume 18, issue 4, October-November-December 2015

Author
AP-HP
Hôpital universitaire Robert-Debré
Service de néphrologie pédiatrique
48, boulevard Sérurier
75935 Paris cedex 19<!--LBREAK--France
* Tirés à part

More than 90% of children with idiopathic nephrotic syndrome (INS) experience remission with steroid treatment. However, 80% experience relapses and around 60% require long-term corticotherapy to remain in remission. Prolonged use of corticotherapy leads to a number of side effects and in order to avoid them, immune modulators or immune suppressors may be prescribed. Traditionally, cyclosporine and cyclophosphamide have been used as immunosuppressive treatment strategies in such cases, but toxicity limits their use. For more than 10 years, numerous clinical reports have demonstrated the efficacy of mycophenolate mofetil (MMF) in steroid-dependent nephrotic syndrome (NS). Due to the lack of nephrotoxicity, cyclosporine is now considered only in the event of MMF treatment failure. More recently, rituximab has emerged as a new treatment option in cases of calcineurin inhibitor dependency. However, while treatment of the primary course of INS is well established, steroid-dependent NS management continues to pose challenges and there is a need to define appropriate treatment depending on patients’ individual characteristics.