Nephrotic Syndrome - Pediatric Oncall

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Nephrotic syndrome

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Question
23rd March 2004 Debol Mukherjee 1/7, Sree colony Kolkata-72 Tel: 033 24128963 Sub: An advice for a patient of 5 years old suffering from nephrotic syndrome. Dear Sir, My name is Sujaya Mukherjee. I stay at Sreecolony, Kolkata. My son Master Soham Mukherjee date of birth 9th May 1998 has been suffering from nephrotic syndrome since 5th August 2003.His disease relapsed for four times. Now he is taking Prednisolone 30 mg steroid (everyday) and livamisol 75 mg on each alternate days. Now Doctor advised him to take Cyclophosphamide 50 mg/day for 75 days and Prednisolone 30 mg for each alternate day.It seems he is okay when steroid is at a high dose and he becomes ill when the dose is low. I am very anxious about him and want to get your valuable advice. Kindly advice me what to do. Presently he is under Dr. Sarmistha Banerjee, paediatric nephrologists. Thanking you for your kind advice. Looking forward to hear from you, With regards, Sujaja Mukherjee (M/O Soham Mukherjee ) CASE HISTORY His disease relapsed for 4 times on August 2003, November 2003, February 2004 and March 2004 Date Weight Symptom Medicines Remarks 05.08.2003 25 kg Admitted to Park Nursing Home for 15 days after swollen his total body along with his penis and bladder. Prednisolone 40 mg /day from 7/8 to 21/9. Wt came down to 19 kg on 22.08.03 22/9 to 7/11/07 19kg Prednisolone 30 mg alternate days 10.11.04 24 kg. Caught cold and relapsed. Used Azithral200 once daily for 5 days. 17th November 25 Kg. 1) Taximo 100mg twice daily for 5 days.2) Prednisolone 25 mg twice daily. 20th December 2003 Wt 25 Cold and cough 1)Azithral 250 mg 5 days.2)Prednisolone 40 mg days alternate for two weeks and 30 mg alt days for two weeks. 2nd February 2004 24 kg 1)Levamisole 50mg 1 tab alternate days.2)Cemexo 100 mg twice daily for 7 days 16th Feb 2004 25 kg : Relapsed 1)Levamisole 50, 75 mg/alternateday 2) Prednisolone 50 mg/day until urine negative for protein.. And 30 mg/alternateday after negative result and is still continuing.20 mg alt.day for 4 weeks 10 mg alt 4 weeks. 8.03.2004 25 kg Relapsed Azithral 250 mg for 5 days1)Levamisol 5mg/day2)Prednisolone30mg/day 22.03. 2004 24 kg Prednisolone 30 mg/day for 3dLevamisole-75mg to continue.. 21.Cyclophosphamide 50 mg /day for 75 days.: 2> Prednisolone 30 mg daily for 3 days and 30 mg alternate days to continue. Still continuing Prednisolone 30 mg.Whenever he caught cold his problem relapsed.
Answer
From the history, he seems to be a steroid dependent nephrotic syndrome (i.e. he requires a low dose of steroid constantly to maintain remission). Since he has already received lot of steroids and levamisole does not seem to work, the best option would be to put him on cyclophosphamide as a steroid sparing agent. Long term high dose steroids have lot of side effects such as cataracts, brittle bones, high blood pressure, muscle weakness etc. To prevent these complications and also maintain him in remission for a longer time, cyclophospahmide can be tried for a period of 3 months. Cyclophosphamide may require lot of monitoring in form of complete blood count weekly as it can cause the counts to drop and also testicular toxicity. Your nephrologist has rightly advised you and you need to maintain your child under strict monitoring and treatment as nephrotic syndrome has a course of relapses and remissions. The goal is to prevent protein loss in the urine and maintain normal functions of the kidney. Back to All Questions

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