PULSE METHYLPREDNISOLONE (MP) THERAPY OF NEPHROTIC SYNDROME WITH FOCAL GLOMERULOSCLEROSIS (FGS)

Seven children with nephrotic syndrome resistant to 8 weeks of oral prednisone at a doses of 2 mg/kg/day and biopsyproven FGS were treated with intravenous MP (30 mg/kg/dose) and alternate day prednisone. MP was given three times a week for two weeks and then at increasing intervals. All seven patients had a marked decrease in edema and urinary protein excretion and an increase in serum albumin concentration. Three patients were treated with an alkylating agent in addition to the high dose MP to produce a sustained remission. The clinical remissions lasted from one to twenty months. Six out of seven patients are in remission and edema free after a mean of 10.5 months on therapy. One patient developed a cataract shortly after being started on MP and immediately after a prolonged course of high-dose daily prednisone. Another patient developed hypertension early in the course of MP therapy which resolved as the interval between MP infusions was increased. No other adverse reactions were observed. It would appear that intravenous MP in high doses causes a significant improvement in the short-term morbidity of FGS. The long-term effects of this treatment remain to be determined.