Nehprotic Syndrome

Question
Dear Dr ,



THis is regarding My daughter, Yashasi. 9 yr old.

Miss Yashaswi born on June 14, 2000; had onset of nephrotic syndrome in August 2001. She was steroid dependent with poor response to Levamisole and Cyclophosphamide. The relapsing dose was 15mg steroids on alternate day. She had a kidney biopsy in April 2005, which showed minimal change disease on light microscopy with deposits of IgM on immunofluorescence. She has been receiving Cyclosporin since then. CyA was started in the dose of 0.6 ml twice a day which was reduced subsequently to 0.5 ml twice a day (since the CyA trough level was 195 ng/ml). The steroids have been tapered. Currently she is in remission. Her blood pressure and renal functions are normal. Her weight is 24 kg and height 110 cms.

She has very frequent cough and cold and so doctors prescribe her antobiotics for the same . Some times,  her albumin reading in urine remain at + 4 for a longer time 5-6 days or so, as per the advice from the doctor, we need to give her disage of Prednislone ( 20 mg twice a day ) and once it become NiL, we gradually bring down the dosage and then stop the same .



Sir, would like to have your advice on the above. Is the current doctor(s) are treating her with the right method . What could be the other options for her treatment. Your response to this will be of immense help for me



Best Regards

Gyan  


Answer
Hi Gyan,



Thanks for your question on "Allexperts".



I agree with your doctor. However, long term cyclosporine has its own side effects. Please discuss with your doctor the role of ACE inhibitors and/or ARBs in the management.



Sincerely,



Dr. Shah