RESUMO
AIMS: We herein report the results of intravenous pulse cyclophosphamide (IVCP) therapy of 5 patients with steroid-resistant focal segmental glomerulosclerosis (FSGS). All patients had been treated with oral and intravenous pulse methylprednisolone and failed to respond to steroids from onset and were considered as primary steroid-resistant. Before starting IVCP, all patients were also treated with other immunosuppressive drugs with or without steroids, but none of them responded to such therapies and no patient had any NPSH2 gene mutations. METHODS: IVCP was given monthly at a dose of 500 mg/m2 for 6 months. At the end of 6 months, IVCP was discontinued in case there was no response. Otherwise, IVCP was continued for every 2 months. Oral prednisone was given concurrently at 60 mg/m2 daily for 6 weeks and then 40 mg/m2 on alternate days for 4 weeks. Prednisone was then tapered to 10 mg/m2 alternate days and continued during the therapy period. RESULTS: Only 1 of these patients achieved remission after IVCP while 4 patients showed no response to IVCP. 2 patients who did not achieve remission progressed to end-stage renal disease (ESRD) and 2 others who had not been treated with cyclosporine before underwent cyclosporine therapy. None of our patients has suffered from adverse effects of IVCP. CONCLUSION: We found that IVCP had a limited beneficial effect in treatment of steroid-resistant FSGS and it may be suggested that IVCP can be tried to treat steroid-resistant patients, also for patients with primary steroid resistance and those who do not respond to other immunosuppressive therapies.
Assuntos
Ciclofosfamida/administração & dosagem , Glomerulosclerose Segmentar e Focal/tratamento farmacológico , Imunossupressores/administração & dosagem , Administração Oral , Adolescente , Anti-Inflamatórios/administração & dosagem , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Injeções Intravenosas , Masculino , Metilprednisolona/administração & dosagem , Prednisona/administração & dosagem , Pulsoterapia , Resultado do TratamentoAssuntos
Espondiloartropatias/complicações , Arterite de Takayasu/complicações , Adolescente , Azatioprina/uso terapêutico , Feminino , Artéria Femoral/diagnóstico por imagem , Artéria Femoral/patologia , Glucocorticoides/uso terapêutico , Humanos , Imunossupressores/uso terapêutico , Imageamento por Ressonância Magnética , Artéria Mesentérica Superior/diagnóstico por imagem , Artéria Mesentérica Superior/patologia , Oclusão Vascular Mesentérica/diagnóstico por imagem , Oclusão Vascular Mesentérica/patologia , Radiografia , Obstrução da Artéria Renal/diagnóstico por imagem , Obstrução da Artéria Renal/patologia , Articulação Sacroilíaca/patologia , Espondiloartropatias/tratamento farmacológico , Espondiloartropatias/imunologia , Espondiloartropatias/patologia , Arterite de Takayasu/tratamento farmacológico , Arterite de Takayasu/imunologia , Arterite de Takayasu/patologia , Resultado do TratamentoRESUMO
Beckwith-Wiedemann syndrome is a somatic overgrowth syndrome characterized by a variable incidence of congenital anomalies, including hemihypertrophy, omphalocele, macroglossia and renal malformations. We report a child with Beckwith-Wiedemann syndrome and posterior urethral valves. Urethral valve resection was successfully performed under general anesthesia after voiding cystourethrography. This is the first report of Beckwith-Wiedemann syndrome associated with posterior urethral valves.