Quantitative morphometry of renal biopsies prior to cyclosporine in nephrotic syndrome.
Use of cyclosporine (CsA) in the management of children with steroid-resistant (SRNS) and steroid-dependent (SDNS) nephrotic syndrome has become increasingly popular in recent years. Although most children receive a renal biopsy prior to initiation of CsA, the relationship between initial renal histology and the subsequent clinical response to CsA is not known. We analyzed the correlation between pre-CsA segmental and global glomerular scarring and interstitial fibrosis and the subsequent response to CsA in 23 children (5.6+/-1.0 years, Mean+/-SEM) with SDNS (n=8) and SRNS (n=15) treated with CsA for 24.2+/-3.8 months and followed for 28.0+/-4.1 months. Complete remission was obtained in 78% of patients within 67.6+/-16 days, while 18% had a partial response and 4% no response. Quantitative histological analysis revealed a trend toward partial rather than complete response with increasing segmental glomerular (P=0.13), global glomerular (P=0.05), and interstitial (P=0.08) scarring, and among patients with minimal change nephrotic syndrome versus IgM nephropathy versus focal segmental glomerulosclerosis. Among complete responders, linear regression analyses revealed no correlation between time to response and pre-CsA glomerular or interstitial scarring. We conclude that increased glomerular or interstitial scarring on a pre-CsA renal biopsy tends to correlate with a partial, rather than complete, response to CsA in childhood nephrotic syndrome.
Smoyer
W E
WE
Department of Pediatrics, University of Michigan, Ann Arbor, USA.
Gregory
M J
MJ
Bajwa
R S
RS
Johnson
K J
KJ
Bunchman
T E
TE
D000293:Adolescent; D000893:Anti-Inflammatory Agents / Q000627:therapeutic use; D002648:Child; D002675:Child, Preschool; D016572:Cyclosporine / Q000627:therapeutic use*; D004351:Drug Resistance; D005260:Female; D005355:Fibrosis; D015432:Glomerulonephritis, Membranoproliferative / Q000188:drug therapy / Q000378:metabolism / Q000473:pathology / Q000503:physiopathology; D005923:Glomerulosclerosis, Focal Segmental / Q000188:drug therapy / Q000473:pathology / Q000503:physiopathology; D006801:Humans; D007075:Immunoglobulin M / Q000378:metabolism; D007166:Immunosuppressive Agents / Q000627:therapeutic use*; D007223:Infant; D007668:Kidney / Q000473:pathology* / Q000503:physiopathology; D007677:Kidney Function Tests; D008297:Male; D009404:Nephrotic Syndrome / Q000188:drug therapy* / Q000473:pathology* / Q000503:physiopathology; D013256:Steroids
D000893:Anti-Inflammatory Agents; D007075:Immunoglobulin M; D007166:Immunosuppressive Agents; D013256:Steroids; D016572:Cyclosporine