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Evaluation and management of steroid-sensitive nephrotic syndrome

Hodson, Elisabeth Ma,b; Alexander, Stephen Ia,c

Current Opinion in Pediatrics: April 2008 - Volume 20 - Issue 2 - p 145–150
doi: 10.1097/MOP.0b013e3282f4307a
Nephrology: Edited by Michel Baum
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Purpose of review This review examines new literature published in 2006 and 2007 on steroid-sensitive nephrotic syndrome.

Recent findings Steroid-sensitive nephrotic syndrome has long been thought to be due to lymphocyte-derived circulating factors leading to podocyte injury with subsequent proteinuria. New studies support this mechanism and implicate the T helper 2 cytokine IL-13. In addition a genetic mutation in familial nephrotic syndrome has been reported in a child, who responded to corticosteroid therapy. There are new clinical trial data supporting the efficacy of levamisole in steroid-sensitive nephrotic syndrome and preliminary trial data on mycophenolate mofetil supporting its efficacy as a steroid-sparing agent. Case reports support the use of the B cell-depleting antibody rituximab in steroid-sensitive nephrotic syndrome. Finally there is a meta-analysis of six studies suggesting an increase in the incidence of focal and segmental glomerulosclerosis in steroid-sensitive nephrotic syndrome over the last 20 years.

Summary Progress has been made towards elucidating the cause of steroid-sensitive nephrotic syndrome. Data from adequately powered randomized controlled trials are still required to evaluate therapies for frequently relapsing and steroid-dependent steroid-sensitive nephrotic syndrome.

aCentre for Kidney Research, The Children's Hospital at Westmead, Australia

bSchool of Public Health, Australia

cDiscipline of Paediatrics, University of Sydney, Sydney, Australia

Correspondence to Dr Elisabeth Hodson, Centre for Kidney Research, The Children's Hospital at Westmead, Locked Bag 4001, Westmead, NSW 2145, Australia Tel: +61 2 9845 3430; fax: +61 2 9845 3432; e-mail: Elisah@chw.edu.au

© 2008 Lippincott Williams & Wilkins, Inc.