Evidence map›Paper›PMID 39576325›Full record

ArticlePediatric nephrology (Berlin, Germany)2025

Prolonged remission after cyclophosphamide or tacrolimus treatment in childhood nephrotic syndrome: a cohort study.

Cal H Robinson, Nowrin Aman, Tonny Banh, Josefina Brooke, Rahul Chanchlani, Vaneet Dhillon, Valerie Langlois, Leo Levin, Christoph Licht, Ashlene McKay and 8 more

Abstract read
PubMed Publisher
In one paragraph

Article in Pediatric nephrology (Berlin, Germany), 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 5 papers.

0numbers the graph read from it
0cells of the map it votes in
5citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

5 citing papers in PubMed.

  1. Review
  2. Article
  3. Article
  4. Challenging Clinical Practice Guideline Definitions in Childhood Nephrotic Syndrome.Clinical journal of the American Society of Nephrology : CJASN · 2025
    Article
  5. Observational
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

18 authors.

Cal H RobinsonDivision of Nephrology, The Hospital for Sick Children, Toronto, ON, Canada. cal.robinson@sickkids.ca.
Nowrin AmanChild Health Evaluative Sciences, Research Institute, The Hospital for Sick Children, Toronto, ON, Canada.
Tonny BanhChild Health Evaluative Sciences, Research Institute, The Hospital for Sick Children, Toronto, ON, Canada.
Josefina BrookeDivision of Nephrology, The Hospital for Sick Children, Toronto, ON, Canada.
Rahul ChanchlaniDivision of Nephrology, Department of Pediatrics, McMaster Children's Hospital, Hamilton, ON, Canada.
Vaneet DhillonDivision of Nephrology, The Hospital for Sick Children, Toronto, ON, Canada.
Valerie LangloisDivision of Nephrology, Department of Paediatrics, Montreal Children's Hospital, Montreal, QC, Canada.
Leo LevinDivision of Nephrology, The Hospital for Sick Children, Toronto, ON, Canada.
Christoph LichtDivision of Nephrology, The Hospital for Sick Children, Toronto, ON, Canada.
Ashlene McKayDivision of Nephrology, The Hospital for Sick Children, Toronto, ON, Canada.
Damien NooneDivision of Nephrology, The Hospital for Sick Children, Toronto, ON, Canada.
Alisha ParikhChild Health Evaluative Sciences, Research Institute, The Hospital for Sick Children, Toronto, ON, Canada.
Rachel PearlDivision of Nephrology, The Hospital for Sick Children, Toronto, ON, Canada.
Seetha RadhakrishnanDivision of Nephrology, The Hospital for Sick Children, Toronto, ON, Canada.
Veronique RowleyChild Health Evaluative Sciences, Research Institute, The Hospital for Sick Children, Toronto, ON, Canada.
Chia Wei TeohDivision of Nephrology, The Hospital for Sick Children, Toronto, ON, Canada.
Jovanka H Vasilevska-RistovskaChild Health Evaluative Sciences, Research Institute, The Hospital for Sick Children, Toronto, ON, Canada.
Rulan S ParekhDivision of Nephrology, The Hospital for Sick Children, Toronto, ON, Canada.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundSteroid-sparing immunosuppression is used in 50% of children with nephrotic syndrome, to prevent relapses and steroid-related toxicity. However, rates and predictors of prolonged remission after cyclophosphamide and tacrolimus are uncertain.

methodsRetrospective analysis of children (1-18 years) enrolled in a longitudinal cohort. We included children diagnosed with steroid-sensitive nephrotic syndrome between 1996-2019 from Toronto, Canada. The exposure was cyclophosphamide or tacrolimus initiation. The primary outcome was prolonged remission (no further relapse or steroid-sparing immunosuppression). We evaluated predictors of prolonged remission and calcineurin inhibitor nephrotoxicity by logistic regression.

resultsOf 578 children with steroid-sensitive nephrotic syndrome, 252 received cyclophosphamide and 120 received tacrolimus. Over median 5.4-year (IQR 2.4-9.1) follow-up, prolonged remission occurred in 72 (28.6%) after cyclophosphamide and 17 (14.2%) after tacrolimus. Relapse frequency decreased after initiation of either medication. Lower prior relapse rate, more recent treatment era, and female sex were predictive of prolonged remission after cyclophosphamide treatment. Use of tacrolimus as the first steroid-sparing medication was the only factor predictive of calcineurin inhibitor nephrotoxicity.

conclusionsLess than one-third of children achieve prolonged remission after initiating cyclophosphamide or tacrolimus, although both reduce short-term relapse rates. Few factors predict prolonged remission after cyclophosphamide or tacrolimus use, or calcineurin inhibitor nephrotoxicity.

Indexed as

CyclophosphamideImmunosuppressive AgentsNephrotic SyndromeTacrolimusAdolescentCalcineurin InhibitorsChildChild, PreschoolFemaleHumansInfantLongitudinal StudiesMaleRecurrenceRemission InductionRetrospective StudiesCalcineurin InhibitorsCyclophosphamideImmunosuppressive AgentsTacrolimusCalcineurin inhibitorsChildCyclophosphamideImmunosuppression therapyNephrotic syndromeTacrolimus

Identifiers

PMID39576325

What Socratic holds

Textmetadata
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the Socratic graph.