1. Failure of steroid treatment in nephritic syndrome

2. Cyclophosphamide  Dosage : 2.5-3 mg/kg/day for 8-12 wks  2-yr remission rate : 60 %  Alternate-day prednisolone therapy is often continued  Side effects : leukopenia, hemorrhagic cystitis, alopecia, sterility, and long-term risks of hematologic malignancy  Cautions : WBC must be monitored, withheld if < 3000/mm 3

3. Cyclosporine  Dosage : 3-5 mg/kg/day for 6-12 mo  Remission rate : 75% in steroid-dependent relapser  Relapse is common within 3 months of stopping treatment (52%)  Side effects : nephrotoxicity, HTN, gingival hyperplasia, hirsutism  Cautions : Monitor blood level, Cr, BP

4. Levamisole  Dosage : 2.5 mg/kg on alternate days  Immunomodulatory effect ?  Most relapse within 3 months of stopping the drug, but provide a relatively nontoxic alternative to steroid until spontaneous remission occurs  Side effects: liver toxicity, vasculitic rash, reversible neutropenia, encephalopathy  rare

5. Mycophenolate Mofetil (CellCept)  Dosage: 0.8-1.2 g/m2/day  Preliminary study demonstrates that children with frequently relapsing MCNS may be beneficial with MMF without major side effects.  Side effects: Leukopenia, GI discomfort, diarrhea, malaise

6. Others  Chlorambucil dosage : 0.2 mg/kg/day for 2 months dosage : 0.2 mg/kg/day for 2 months similar effect to cyclophosphamide similar effect to cyclophosphamide  Azathioprine not proven in the management of children with minimal change dz not proven in the management of children with minimal change dz  Pulse methylprednisolone  Pulse cyclophosphamide