A 7-year-old child with steroid dependent nephrotic syndrome has developed coicosteroid toxicity and posterior subcapsular cataracts. Which of the following is the best alternative for the treatment of the patient?
Steroid-dependent patients, frequent relapses, and steroid-resistant patients may be candidates for alternative agents, paicularly if the child suffers severe coicosteroid toxicity (cushingoid appearance, hypeension, cataracts, and/or growth failure). Cyclophosphamide prolongs the duration of remission and reduces the number of relapses in children with frequently relapsing and steroid-dependent nephrotic syndrome. The potential side effects of the drug (neutropenia, disseminated varicella, hemorrhagic cystitis, alopecia, sterility, increased risk of future malignancy) should be carefully reviewed with the family before initiating treatment. The dose of cyclophosphamide is 2-3 mg/kg/24 hr given as a single oral dose, for a total duration of 8-12 wk. Alternate-day prednisone therapy is often continued during the course of cyclophosphamide administration. During cyclophosphamide therapy, the white blood cell count must be monitored weekly and the drug should be withheld if the count falls below 5,000/mm3
Levamisole
Cyclophosphamide
Mycophenolate mofetil
Rituximab
Nephritic & Nephrotic Syndrome