Leading article

The treatment of steroid sensitive nephrotic syndrome U D Mahamithawa1 Sri Lanka Journal of Child Health, 2002; 31: 60-2 (Key words: steroid sensitive nephrotic syndrome, SSNS, treatment) Due to an oversight, a part of the above article was omitted from the last issue of the journal. We are now Children with frequent relapses usually remain Frequently relapsing and steroid dependent MCNS There are no randomized controlled trials These children are difficult to treat and develop steroid comparing repeated courses of standard relapse toxicity. The first step in management is to identify therapy with long term low dose alternate day frequent relapsers and steroid dependence accurately, using the definitions given. This requires the prednisolone therapy for frequent relapses. paediatrician to spend time evaluating the course of the disease and the treatment given throughout. The definitions are applicable only if standard relapse treatment has been used in the preceding relapses. cyclosporin or levamisole substantially reduce Cyclosporin and levamisole effectively induce The relative efficacy of levamisole is not known. In the remission, but are unable to sustain this effect University Paediatric unit, at the Lady Ridgeway Hospital for Children, we have been using this drug since 1993. A 10 year review of 110 children with There is insufficient data at present to show that SSNS followed up by us showed that levamisole was alkylating agents are more effective than able to induce remissions lasting 2 years or longer and cyclosporin or levamisole in reducing the there was no statistically significant difference in efficacy when compared with cyclophosphamide14. However, it appears as though levamisole is more effective in the milder forms of the disease. We have not encountered any serious side effects with this drug to Treatment protocol for children with SSNS This protocol is a modified version of the guidelines set out by the British Association for Paediatric This drug is nephrotoxic and therefore can be used only if facilities are available to monitor drug levels very regularly. The Medical Research Institute has recently commenced assessing blood levels of cyclosporin, but this is done only on 2 specified days of the week. The very high cost of the drug and the problems of assessing blood levels regularly makes it difficult for us, in Sri __________________________________________ 1Senior Lecturer in Paediatrics, Faculty of Medicine, Maintenance Prednisolone 0.1-0.5mg/kg/EOD for 6 months Slow withdrawal over another 6 months prednisolone therapy for initial treatment of minimal change nephrotic syndrome. Paediatr idiopathic nephrotic syndrome in children. 2. Shaloup R J. Pathogenesis of lipoid nephrosis: 11. Hodson E M, Knight J F, Willis N S, Craig J a disorder of T-cell function. Lancet 1975; II: controlled trials. Arch Dis Child 2000; 83: 45- 12. International study of Kidney Diseases in Children. Nephrotic syndrome in children. Nephrology, Alternate day versus intermittent Randomized trial comparing 2 prednisolone prednisolone in frequently relapsing nephrotic regimes in steroid responsive patients who relapse early, J. Pediatri 1979; 95: 239 -43. 5. Ueda N, Chihara M, Kamaguchi S, Niinomi Y, 13. Durkan A M, Hodson E M, Willis N S, Craig J Nonoda T, et al. Intermittent versus long term C. Immunosuppressive agents in childhood tapering prednisolone for initial therapy in children with idopathic nephrotic syndrome. J. randomized controlled trials. Kidney Int. 2001; 6. Ksiazek J, WyszyNska T. Short versus long initial prednisolone treatment in steroid 14. Mahamithawa U D, Hubert H D N, Bahirathan sensitive nephrotic syndrome in children. Acta S. Use of alternative treatment in SSNS - A ten International Congress of Tropical Pediatrics 7. Ehrich J H H, Brodehl J. Arbeitsge meinschaft far Paeuaa-trusche Nephrologie, Long versus standard pred nisolone therapy for initial treatment of idiopathic nephrotic syndrome in Association for Paediatric Nephrology and children. Eur J. Pediatr. 1993; 152: 357-61. Research Unit, Royal College of Physicians. Consensus statement on management and audit 8. Ekka B K, Bagga A, Srivastava R N, Single potential for steroid reponsive nephrotic versus divided dose prednisolone therapy for syndrome. Arch Dis.Child 1994; 70: 151-7. relapses of nephrotic syndrome. Paediatr. 9. International Study of Kidney Diseases in Children, Early identification of frequent relapsers among children with MCNS. J. Paediatr. 1982; 101: 514-8.

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