Corticoid resistant nephrotic syndrome.

Abstract

The authors present a case report on a eighteenth months old male white, who was admitted at the Nephrology Unit with nephrotic syndrome--first episode. Considering the age of the patient, the laboratorial results and the negative result of the immunologic study, the first diagnostic hypothesis was the minimal lesions nephrotic syndrome and was initiated treatment with corticosteroid in the dosis of 60 mg per square meter, per day. The generalized oedema and the massive proteinuria persisted although the corticosteroid and additional therapy. At the sixth week the renal biopsy revealed membranous glomerulonephropathy with mesangial deposits of IgG, IgA, IgM, C3, C4, C1q, compatible with an immunologic disease and suggestive of lupus nephritis. Then, was initiated the therapeutic protocol with 6 menstrual pulses of intravenous cyclophosphmide. After the 4th pulse of cyclophosphamide the proteinuria was negative, and the patient remains in clinical and laboratorial remission since the end of the 6 pulses, and after 14 months of follow-up.