Galactose treatment in focal and segmental glomerulosclerosis

Abstract

Sirs,We read with interest the article entitled “Effect of galactoseonglomerularpermeabilityandproteinuriainsteroid-resistantnephrotic syndrome” by Sgambat et al. recently published inPediatricNephrology[1].Inthisprospectiveclinicaltrial,oralgalactose was administered in seven pediatric patients withsteroid-resistant nephrotic syndrome for a 16-week period toobserve reductions in focal sclerosis permeability factor(FSPF)andproteinuria.Thoughtherewasasignificantreduc-tioninmeanFSPFactivityinthepost-treatmentphase(0.69±0.11 to 0.35±0.21, p=0.009), mean urine protein/creatinine(UPC) ratios did not differ significantly between pre- andpost-treatment periods (15.5±18.9 vs. 20.8±25.2 g/g, respec-tively). If we look at the data of UPC ratios carefully, itfollowed non-Gaussian distribution and paired Student’st-test applied for comparison was inappropriate. Therefore, itmade the data difficult to interpret. In such data, non-parametric test Wilcoxon signed-rank test should have beenapplied with calculations of median and interquartile range.We observed reductions in UPC ratios and an increase inserum albumin levels following oral galactose administrationin three patients with focal segmental glomerulosclerosis(FSGS) who were unresponsive to cyclosporine, predniso-lone, and ramipril therapy given for 11–14 months. Thebenefit was demonstrated twice (first course for 90 days andsecond for 30 days) and deterioration of parameters occurredafter discontinuation of galactose. As such, no patientsachieved complete remission (UPC <0.2), but there weredefinite reductions in UPC ratios in all our three patients [2].Kopacetal.[3]observedabeneficialeffectofgalactoseintwopediatric patients and the effect persisted for 3 months in onechild. However, we observed benefit as long as galactosetreatment was continued; implying the effect was duration-dependent. In conclusion, oral galactose can be tried as anadjunct therapy to reduce heavy proteinuria in unresponsiveFSGS patients.References