Steroid-resistant nephrotic syndrome (SRNS) in children carries a significant risk of progression to end-stage renal failure (ESRF). We report a two-step protocol adapted in children with SRNS. Thirty-seven SRNS were treated with cyclosporine A (CyA) in association with prednisolone (alternate day) for 6 months (first-step treatment). Twelve patients (32.4%) went into complete remission, and 2 (5.4%) got partial remission. The other 23 cases who were steroid and CyA resistant entered a second-step treatment with withdrawing steroids, with CyA (5 mg/kg/day) in association with mycophenolate mofetil (MMF) 30 mg/kg/day for 6 months. Complete remission was observed in 11 cases (47.82%) and partial remission in 2 cases (8.7%). After two steps of treatment, 27/37 children went into total remission. In steroid and CyA-resistant INS, the association of MMF with CyA was able to induce remission in about half cases without relevant side effects.
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机译：儿童类固醇抗性肾病综合征（SRNS）具有发展为晚期肾衰竭（ESRF）的重大风险。我们报告了适用于SRNS儿童的两步协议。将37例SRNS与环泼尼松龙（交替使用）一起用环孢素A（CyA）治疗6个月（第一步治疗）。 12名患者（32.4％）完全缓解，2名（5.4％）部分缓解。其余23例对类固醇和CyA耐药的患者进入第二步治疗，停用类固醇，同时给予CyA（5μmg/ kg /天）和霉酚酸酯（MMF）30μmg/ kg /天，共6个月。完全缓解11例（47.82％），部分缓解2例（8.7％）。经过两步治疗，共有27/37名儿童完全缓解。在类固醇和耐CyA的INS中，MMF与CyA的结合能够在大约一半的病例中诱导缓解，而没有相关的副作用。
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