چاپ صفحه |  صفحه نخست سامانه |  نویسندگان |  اطلاعات تفضیلی |  دانلود مقاله | دانشگاه علوم پزشکی تبریز |
| نویسنده | نفر چندم مقاله |
|---|---|
| افشین قلعه گلاب بهبهانی | اول |
| عنوان | متن |
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| خلاصه مقاله | Introduction: Primary nephrotic syndrome is the most common chronic renal disorder of childhood, therefore its treatment is an important issue for pediatricians all around the world. Discussion: Despite of abundant controversies in medical literature about treatment of primary nephrotic syndrome in children; it could be summarized into simple but precise steps as mentioned in following sequential recommendations: Line 1: Initial corticosteroid as a single daily dose of oral Prednisolone at 60 mg/m2 /day (max: 60 mg/day) for 4–6 weeks; if remission induced, followed by alternate-day dosing: 40 mg/m2 /day for 4 weeks, and then dose tapering during next 2–5 months. Total therapy should be at least 3 and at most 7 months. Line 2; these drugs should be used if the patient on steroid has frequent relapses and also steroid resistance, dependency or toxicity (as steroid-sparing agent): Levamisole: 2.5 mg/kg on alternate days for 6 to 12 months. (less useful for steroid dependency) Cyclophosphamide: 2 mg/kg/single daily dose, for 8 weeks. (not useful for established FSGS) Calcineurin inhibitors (CNI): Cyclosporine: 1.5 - 2.5 mg/kg/dose bid (for children under 5 years, 1-2 mg/kg/dose tid may be preferred) or Tacrolimus: 0.05 mg/kg/dose bid; usually for 1-3 years. Both are effective steroid-sparing agents and need periodic dose adjustment based on trough plasma concentrations of 50–125 ng/mL for cyclosporine and 5-8 ng/mL for tacrolimus. Line 3: Mycophenolate mofetil: 600/m2 /dose bid, it can reduce relapse rate in frequent relapsers and shows significant corticosteroid-sparing effect. Besides, it has been recommended for chronic nephrotic cases with signs of CNI toxicity. Line 4: Rituximab: 375mg/m2 /dose once weekly for 4 doses, it induces remission in frequent relapsers and also steroid dependent patients but shows no benefit for steroid resistance and FSGS. Drugs for supportive treatment: angiotensin converting enzyme inhibitors (e.g. Enalapril) and/or angiotensin receptor blockers (e.g. Losartan) may be used for non-specific reduction of nephrotic range proteinuria. Albumin (20%) 1 gm/kg (or 5 ml/kg) with 1-2 mg/kg of furosemide for intravenous infusion over 4 to 6 hours are used to obviate intra-vascular volume depletion or seriously symptomatic edema. A low serum albumin is not an indication for albumin infusion. Conclusion: children with nephrotic syndrome need different treatments in different situations |
| کلمات کلیدی | Treatment of Primary Nephrotic Syndrome in Children |
| نام فایل | تاریخ درج فایل | اندازه فایل | دانلود |
|---|---|---|---|
| Congress of Children and Neonates Update, Tabriz, 2018.pdf | 1398/06/18 | 1335060 | دانلود |
| Certificate - Congress of Children and Neonates Update, Tabriz, 2018.pdf | 1398/06/18 | 108518 | دانلود |
