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Nephrol Dial Transplant (2004) 19: 1328
Nephrol Dial Transplant Vol. 19 No. 5 © ERA-EDTA 2004; all rights reserved

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Sir,

In our study [1], nine patients completed the 6-month pulse cyclophosphamide therapy, a number that approaches that of the study by Bircan and Kara [2]. However, only one (11.1%) of them has maintained remission 2 years after stopping cyclophosphamide. Additionally, in the earlier study concerning oral cyclophosphamide in steroid-dependent nephrotic patients [3], despite the fact that steroids were continued throughout the 12-week cyclophosphamide course, the authors concluded that it is unlikely that this could be responsible for better results according to their earlier study in 1981. On the other hand, cumulative steroid dose was higher in the study by Bircan and Kara [2]. Also, the protocol of steroid withdrawal after stopping cyclophosphamide and the percentage of patients that became steroid independent were not mentioned. Moreover, the claim that ‘long-term side effects were absent’ cannot be completely accepted if there was no testing for gonadal toxicity.

Actually, we are sceptical about the conclusion in Bircan and Kara's study [2] that intravenous cyclophosphamide is the drug of choice for steroid-dependent nephrotic syndrome. Nevertheless, it remains possible that previous adjunctive therapy, renal pathology (neither of which were indicated in the study by Bircan and Kara), racial and genetic factors and selection criteria have an effect on the results obtained.

Conflict of interest statement. None declared.

Ahmed Donia and Mohamed Sobh

Urology and Nephrology Center Mansoura University Mansoura Egypt Email: afdonia{at}hotmail.com

References

  1. Donia AF, Gazareen SH, Ahmed HA et al. Pulse cyclophosphamide inadequately suppresses reoccurrence of minimal change nephrotic syndrome in corticoid-dependent children. Nephrol Dial Transplant 2003; 18: 2054–2058[Abstract/Free Full Text]
  2. Bircan Z, Kara B. Intravenous cyclophosphamide is the drug of choice for steroid dependent nephrotic syndrome. Pediatr Int 2003; 45: 65–67[CrossRef][Web of Science][Medline]
  3. Report of Arbeitsgemeinschaft für Padiatrische Nephrologie. Cyclophosphamide treatment of steroid dependent nephrotic syndrome: comparison of eight week with 12 week course. Arch Dis Child 1987; 62: 1102–1106[Abstract/Free Full Text]

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This Article
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