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How to manage impaired kidney functions in children?

Q: My daughter is 2 years old now. At 4th month she developed ARF and treated with peritoneal dialysis after which she recovered well. At 1.5 years old she had proteinuria 3+ to 4+ and haematuria. She underwent kidney biopsy and result is MPGN (minimal proliferative glomerulonephritis). DMSA scan shows slight inflammation in right upper pole. Both kidneys are normal in size. Kidney Function is 47% and 53%. For the past 6 months she is prednisolone 25 mg and her BP is 130/90. She is also given Envas 5mg twice daily. She is urinating around 10 to 12 times. After taking these medicines her proteinuria reduces from 3+ to 1+ and there is no cast or deposits in urine. Will she recover completely? How long we should continue these medicines and is there any other alternative medicines. I would like to know whether cyclophosphamide can cure this. Whether it is safe to give this for 2 year old child. Is homeopathy or any alternative therapy effective?

A:First of all, a BP of 130/90 is high for a 2 year old child. Proper control of blood pressure is desirable to control the severity of the disease. There is no definite treatment plan for the patients of MPGN, but the mainstay of treatment are steroids. Ideally steroids are given for a long time (4-18 years) in alternate day doses. The dose is adjusted for individual patients, so that the disease process remains under control. The doses are adjusted keeping in mind the side effects of long term steroids. In children, the prognosis is better as compared to adults. About 30-40% of the patients land up with chronic renal failure 10 year after the diagnosis. Drugs like cyclophosphamide are recommended for children who have impaired kidney function or whose biopsy has shown crescentic changes. I don't know of any alternative medicine which can help in this condition. As I have mentioned earlier, steroids are the mainstay of treatment and can be given for prolonged periods under the supervision of an experienced paediatric nephrologist.

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