Children with nephrotic syndrome lose excessive amounts of protein from their bloodstream into their urine, causing swelling, especially in the face, stomach and legs. The risk of infection also increases because important proteins used by children's immune systems have been lost. Corticosteroid drugs, such as prednisone, can stop protein loss, but often happens again (relapse). Giving children further corticosteroids can lead to poor growth, cataracts, osteoporosis and high blood pressure.
To find out if there was evidence about non-corticosteroid drugs for children with nephrotic syndrome, and to assess what the benefits and harms of these drugs were, we analysed 32 studies that enrolled 1443 children. The studies compared several drugs and found that cyclophosphamide, chlorambucil, cyclosporin, levamisole and rituximab reduced the risk of relapse in children with frequently relapsing steroid-sensitive nephrotic syndrome.
We found that more studies are needed that compare different drug treatments to determine how these medicines should be used in children with nephrotic syndrome.