ArticleIndian pediatrics2026
Follow-up Outcomes of 100 Children with Frequently Relapsing and Steroid Dependent Nephrotic Syndrome Treated with Oral Cyclophosphamide: A Retrospective Cohort Study.
Article in Indian pediatrics, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
objectivesThe primary objective was to estimate the proportion of children with frequently relapsing nephrotic syndrome (FRNS) and steroid-dependent nephrotic syndrome (SDNS) responding to oral cyclophosphamide, while secondary objectives were to document adverse effects, evaluate relapse-free survival following therapy, and assess outcomes at the last follow-up.
methodsIn this retrospective cohort study, 100 children aged 1-18 years with FRNS or SDNS who received oral cyclophosphamide (cumulative dose ≤168 mg/kg) between 2010 and 2023 at a pediatric nephrology clinic were included. Demographic characteristics, previous treatments, adverse effects, and relapse patterns were retrieved from medical records. Response was defined as being relapse-free and off steroids for ≥6 months after completion of cyclophosphamide therapy, while sustained remission was defined as absence of relapse for ≥2 years.
resultsThe median (q1, q3) age at onset of nephrotic syndrome was 4 (2.5, 6) years, and oral cyclophosphamide was initiated at 8 (7, 10) years. The response rate to oral cyclophosphamide was 67%, with a median (q1, q3) relapse-free interval of 9.1 (3.9, 24.7) months. Adverse effects occurred in 28%, most commonly nail discoloration (28 cases), followed by transient leukopenia (4 cases). During follow-up, 56% required an alternative steroid-sparing agent. At a median (q1, q3) follow-up of 72.5 (25.5, 107.25) months, 28% achieved sustained remission, while 69% had infrequent relapses.
conclusionOral cyclophosphamide is effective in children with FRNS and SDNS, inducing sustained remission in a significant proportion and suggesting a prolonged therapeutic effect. However, many children require additional immunosuppressive therapy during follow-up.
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