Cyclophosphamide may have significant adverse effects, including bone marrow suppression, gonadal toxicity and malignancy. The development of gonadal toxicity resulting in infertility generally is caused by a total cyclophosphamide dose greater
than 300 mg/kg. Further studies, including controlled trials, are needed to determine the efficacy and safety of mycophenolate mofetil and rituximab for children with refractory FRNS/SDNS. 5. Treatment for steroid-resistant NS (SRNS) We recommend cyclosporine and/or steroid pulse therapy for SRNS treatment. Cyclosporine is effective in inducing remission in patients with SRNS. A small study suggested that cyclosporine and steroid pulse therapy for Japanese patients with focal segmental glomerulosclerosis may be effective in inducing remission. Bibliography 1. International Study of Kidney Disease in Children. J Pediatr. 1981;98:561–4. (Level 4) 2. Tarshish P, Selleck AZD3965 et al. J Am Soc Nephrol. 1997;8:769–76. (Level 4) 3. Cattran DC, et al. Am J Kidney Dis. 1998;32:72–9. (Level 5) 4. Ueda N, et al. J Pediatr. 1988;112:122–6 (Level 2 per protocol analysis). 5. Ehrich JH, et al. Eur
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