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Kidney Diseases

Nephrotic Syndrome, Cellcept and Prednisone

12/18/2009

Question:

Are there any other alternatives to explore for the treatment of "stubborn" nephrotic syndrome? My son is 13 yrs old and diagnosed with minimal change nephrotic syndrome at age 2ys 3 months. He is cortisone dependant and takes cellcept as well as we have been through the other known meds to use, Endoxan, Chloroambusil etc. What other choices are there?

Answer:

I assume that he's under the care of a pediatric nephrologist -- it would be best to sit down with his doctor and discuss your questions.  As you mention, prednisone is the main drug used to treat minimal change disease, and it is usually very effective.  But because of side effects of long-term use of prednisone and cortisone-like drugs, other drugs are given in addition, including cyclophosphamide, chlorambucil, and mycophenolate (Cellcept), as well as levamisole, rituximab, cyclosporine, and tacrolimus.  These are all very potent drugs that are usually used either for cancer chemotherapy or to suppress the immune system, for instance after organ transplantation.  Because of their potentially serious side effects, their use must be very thoughtfully considered and carefully monitored.  Pediatric nephrologists are constantly on the lookout for reports of new medications that may help in treating patients such as your son -- best of luck to you.

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Response by:

Mildred   Lam, MD Mildred Lam, MD
Associate Professor of Medicine
School of Medicine
Case Western Reserve University