Irma Esther Del Moral Espinosa
Hospital Infantil de México Federico Gómez, México
Irma Esther Del Moral Espinosa completed her Medical Degree at Anahuac University, Pediatrics at Mexico’s Infantil de México Federico Gómez Hospital and Pediatric Nephrology at the National Pediatrics Institute in Mexico City. She currently leads the nephrology service at the Mexico’s Children’s Hospital Federico Gómez, the leading renal-transplant hospital in Latin America. She was awarded the best published paper from Latin America by the Pediatrics Association of Spain (2011) for the work “Paricalcitol in children with hyperparathyroidism” and the Best Pediatrics Dissertation (2003) “Enuresis associated to allergy”.
Introduction: 5% of children with idiopathic nephrotic syndrome (NS) present steroid-resistant nephrotic syndrome (SRNS) with the presence of focal segmental glomerulosclerosis (FSGS). Objective: Demonstrate treatment with Prednisone (PDN) and Tacrolimus (FK) in pediatric patients with SRNS for a period of 12 months having greater frequency of complete or partial remissions in relation to the standard treatment with prednisone and Cyclosporine (CyA). Material and Methods: Comparative, multicenter randomized clinical trial was conducted in children with SRNS, approved by Investigation and Ethics Committees; both groups received PDN 60 mg/m2/day, during 1 month continued by 30 mg/m2/ day each/48 h. for 5 months. Group I received CyA 5 mg/kg/day in two doses for 12 month. Through levels 100-200 ng/ml. Group II received FK 0.10 mg/Kg/day in two doses for 12 months. Through levels 5-10 ng/ml. renal biopsy at beginning of treatment and control at 12 months. Cholesterol, albumin and serum creatinine, glomerular filtration rate, proteinuria were determinated in both groups. Results: 20 patients were included, 10 in Group I and 10 in Group II with follow-up of 8 years. Response complete 50% (5) for Group I, 80 % (8) for group II, partial response 10% (1) in group I, no response in 10% (1) of each groups. Secondary hypertension was present in 71.42% for group I and 25% for group II. FSFS were present at 90% biopsies for both groups and no statistical changes of nephrotoxicity. Conclusion: In pediatric patients with SRNS, the treatment FK-PDN had a greater percentage of complete remission than CyA-PDN treatment and lower incidence of hypertension and nephrotoxicity.
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