Renal haemodynamics of cyclosporin A nephrotoxicity in children with juvenile dermatomyositis.
1. Renal haemodynamics were monitored over an average period of 19 months in 17 children being treated with cyclosporin A. Sixteen had juvenile dermatomyositis and one had chronic polyneuropathy. The dose of cyclosporin A ranged from 2.3 to 8.3 mg day-1 kg-1 (median 4.1 mg day-1 kg-1). 2. Glomerular filtration rate (expressed in terms of extracellular fluid volume), renal blood flow (expressed as a fraction of cardiac output) and filtration fraction were measured by using 99mTc-labelled diethylenetriamine-penta-acetate. They were compared with the dosage and trough blood levels of cyclosporin A, and, in 15 patients receiving prednisolone in addition to cyclosporin A, with steroid dosage. 3. All 17 children had a renogram performed 6 months after starting cyclosporin A treatment. Nine of them also had a renogram before starting cyclosporin A treatment (baseline study), while 13, in addition to their renogram 6 months after starting cyclosporin A treatment, also had at least one further renogram. 4. Glomerular filtration rate/extracellular fluid volume fell slightly but significantly from 0.009 (SD 0.0013) before starting cyclosporin A treatment to 0.0085 (0.002) min-1 (P less than 0.01) 6 months after cyclosporin A treatment in the nine children who underwent a baseline study. This was accompanied by a significant (P less than 0.001) fall in filtration fraction from 0.108 (0.015) to 0.088 (0.014). However, renal blood flow/cardiac output showed no change. 5. In the 13 children studied beyond 6 months after starting cyclosporin A treatment, there was no further significant overall change in any renal haemodynamic variable.(ABSTRACT TRUNCATED AT 250 WORDS)
Peters
A M
AM
Department of Diagnostic Radiology, Hammersmith Hospital, London, U.K.
Heckmatt
J Z
JZ
Hasson
N
N
Henderson
B L
BL
el-Meleigy
D
D
Rose
M L
ML
Dubowitz
V
V
D000293:Adolescent; D002648:Child; D003524:Cyclosporins / Q000009:adverse effects* / Q000097:blood; D003882:Dermatomyositis / Q000097:blood / Q000188:drug therapy* / Q000503:physiopathology; D005260:Female; D005919:Glomerular Filtration Rate / Q000502:physiology; D006801:Humans; D007668:Kidney / Q000098:blood supply / Q000503:physiopathology*; D007674:Kidney Diseases / Q000139:chemically induced*; D008297:Male; D011239:Prednisolone / Q000627:therapeutic use; D012039:Regional Blood Flow
D003524:Cyclosporins; D011239:Prednisolone