Cyclosporine A induced remission of relapsing nephrotic syndrome in children.
We treated 20, steroid resistant or steroid dependent and cyclophosphamide or chlorambucil treated, relapsing nephrotic patients with oral cyclosporine A for eight weeks. Cyclosporine A was started at 7 mg/kg/day and titrated to maintain HPLC level of 100 to 200 ng/ml. Of 20 patients, 14 had a complete remission and the remaining 6 had a reduction in their proteinuria. The mean serum albumin of the 14 responders rose from 2.1 g/dl to 4.1 g/dl (P less than 0.00001) after cyclosporine A therapy. The mean serum cholesterol of the 14 responders decreased from 394 mg/dl to 184 mg/dl (P less than 0.0001) after cyclosporine A therapy. The mean creatinine clearance of the 20 patients (104 ml/min/1.73 m2) was unchanged (107 ml/min/1.73 m2) after eight weeks of cyclosporine A. By life table analysis, 40% of the responders show a sustained remission of up to a year. Cyclosporine A responders had a higher T3 cell count prior to therapy compared to nonresponders (69 +/- 5.54% vs. 61 +/- 6.4%, P less than 0.02). Pre-therapy interleukin-2 levels measured in 10 patients were normal or supranormal in 8, 6 of whom were treatment responders. Two patients with low interleukin-2 levels were nonresponders. Cyclosporine A can be used to induce a remission in relapsing nephrotic patients, and short-term cyclosporine A therapy does not produce nephrotoxicity.
Tejani
A T
AT
Department of Pediatrics, State University of New York, Brooklyn.
Butt
K
K
Trachtman
H
H
Suthanthiran
M
M
Rosenthal
C J
CJ
Khawar
M R
MR
D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D003524:Cyclosporins / Q000009:adverse effects / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D007376:Interleukin-2 / Q000096:biosynthesis; D007963:Leukocytes, Mononuclear / Q000378:metabolism; D008213:Lymphocyte Activation; D008297:Male; D009404:Nephrotic Syndrome / Q000188:drug therapy*; D012008:Recurrence; D006377:T-Lymphocytes, Helper-Inducer / Q000166:cytology; D050378:T-Lymphocytes, Regulatory / Q000166:cytology
D003524:Cyclosporins; D007376:Interleukin-2