Generic selectors
Exact matches only
Search in title
Search in content
Post Type Selectors
Search in posts
Search in pages
Filter by Categories
Allied Health Professionals’ Corner
Author Reply
Book Review
Brief Communication
Case Report
Case Series
Clinical Case Report
Clinicopathological Conference
Commentary
Corrigendum
Current Issue
Editorial
Editorial – World Kidney Day 2016
Editorial Commentary
Erratum
Foreward
Guideline
Guidelines
Image in Nephrology
Images in Nephrology
In-depth Review
Letter to Editor
Letter to the Editor
Letters to Editor
Literature Review
Notice of Retraction
Obituary
Original Article
Perspective
Research Letter
Retraction Notice
Review
Review Article
Short Review
Special Article
Special Feature
Special Feature - World Kidney Day
Systematic Review
Technical Note
Varia
Generic selectors
Exact matches only
Search in title
Search in content
Post Type Selectors
Search in posts
Search in pages
Filter by Categories
Allied Health Professionals’ Corner
Author Reply
Book Review
Brief Communication
Case Report
Case Series
Clinical Case Report
Clinicopathological Conference
Commentary
Corrigendum
Current Issue
Editorial
Editorial – World Kidney Day 2016
Editorial Commentary
Erratum
Foreward
Guideline
Guidelines
Image in Nephrology
Images in Nephrology
In-depth Review
Letter to Editor
Letter to the Editor
Letters to Editor
Literature Review
Notice of Retraction
Obituary
Original Article
Perspective
Research Letter
Retraction Notice
Review
Review Article
Short Review
Special Article
Special Feature
Special Feature - World Kidney Day
Systematic Review
Technical Note
Varia
View/Download PDF

Translate this page into:

Letters to Editor
19 (
3
); 126-127
doi:
10.4103/0971-4065.57114

Ponticelli regimen and nephrotic syndrome

Department of Nephrology, Amrita Institute of Medical Sciences, Kochi, Kerala, India

Address for correspondence: Dr. Susheelan Laxminarayan, Department of Nephrology, Amrita Institute of Medical Sciences, Kochi, Kerala, India. E-mail: drlng231@rediffmail.com

Licence

This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Disclaimer:
This article was originally published by Medknow Publications and was migrated to Scientific Scholar after the change of Publisher.

Sir,

We read the article of Das et al.[1] with interest; it raised few questions that beg answers.

Both in children and adults with steroid resistant minimal change disease (MCD) and focal segmental glomerulo sclerosis (FSGS), cyclosporine is the preferred choice.[2] Cytotoxic drug (cyclophosphamide) is indicated in frequent relapsing and/ or steroid dependent/toxicity group of MCD pediatric patients. The article was a mixture of frequent relapsers and steroid resistant nephrotic syndrome (SRNS). It is possible that the patients who improved with this protocol were only frequent relapsers, not affected with SRNS. Presuming that only cyclophosphamide (cytotoxic drug) is sufficient, addition of high dose of steroid adds to the steroid toxicity. The addition of prednisone to the cytotoxic drug may not improve the efficacy of the regimen, but it allows the patient for high fluid intake to protect against the cystitis. In such a case, the dose of steroid is tapered once remission is achieved.[3]

The authors were not explicit about the use of the terms, ‘frequent relapsers’ and ‘steroid resistant’ in the context of membranoproliferative glomerulonephritis and IgA nephropathy. IgA nephropathy is treated when proteinuria >1 g/24 h with preserved renal function with steroid for six months and with progressive renal failure (serum creatinine <2.84 mg/dl), a cytotoxic agent is added. The treatment in the latter group is at least for two years.[4] It is surprising that the lone IgA nephropathy with FR (sic) and renal impairment achieved remission and improvement in renal function at the end of six months. Results in fact did not present clinical and laboratory features of each group of the disease.

With expanding armamentarium to treat nephrotic syndromes, based on it etiology, proteinuria, renal impairment, renal biopsy features and individual merit, the authors surprisingly presented a unifying concept of a common treatment to all nephrotic syndromes, irrespective of its etiology. Is there a message, that the renal biopsy is, now, redundant; treat all with steroids, but if there is no response, use this protocol.[1]

The definition used for ‘renal failure’ in the article was persistent doubling of plasma creatinine over baseline value but the highest serum creatinine, mentioned only in Table 4, was only 1.12 + 0.58 mg/dl. In Table 3, another term ‘renal insufficiency’ was used, but it was not defined in the article.

References

  1. , , . Ponticelli regimen in idiopathic nephrotic syndrome. Indian J Nephrol. 2009;19:48-52.
    [Google Scholar]
  2. , , , , , , . Cycloporin in idiopathic glomerular disease associated with nephrotic syndrome: workshop recommendations. Kidney Int. 2007;72:1429-47.
    [Google Scholar]
  3. , . Minimal change disease. Therapy in Nephrology and Hypertension. In: , ed. A companion to Brenner and rector's The Kidney (3rd ed). Philadelphia: Saunders Elsevier; . p. :205-19.
    [Google Scholar]
  4. . Evidence-based recommendations for immuno-suppression in IgA nephropathy: handle with caution. Nephrol Dial Transplant. 2003;18:241-5.
    [Google Scholar]

Fulltext Views
162

PDF downloads
232
View/Download PDF
Download Citations
BibTeX
RIS
Show Sections