Comparison between pre- and posttreatment clinical and renal biopsies in children receiving low dose ciclosporine-A for 2 years for steroid-dependent nephrotic syndrome.
BACKGROUND
The dose of ciclosporine-A (CSA) for long-term treatment of nephrotic syndrome remains unclear due to the chronic nephrotoxicity of CSA.


METHODS
We examined 14 children with steroid-dependent nephrotic syndrome (SDNS) who showed signs of steroid toxicity and did not respond to cyclophosphamide. CSA was started at a dose between 2.0 and 3.3 mg/kg/day and the CSA dosage was decreased to between 1.6 and 3.1 mg/kg/day 4 months after the initiation of CSA therapy to maintain 40 to 70 ng/ml in the whole blood trough level.


RESULTS
Renal histology before CSA therapy showed minimal changes in all patients. It was possible to discontinue corticosteroid therapy within 3 to 4 months in all patients. The SD score for height significantly improved during CSA therapy. The incidence of CSA side-effects in our patients was lower than previously reported. Post-therapy biopsies after 24 months of CSA treatment showed mild tubular atrophy accompanying stripped interstitial fibrosis in only 1 patient (7%), and positive findings of global sclerosed glomeruli in 2 patients.


CONCLUSIONS
Long-term CSA therapy in low doses was effective for patients with SDNS and demonstrated a low incidence of CSA side-effects including nephrotoxicity.
Kano
K
K
Department of Pediatrics, Dokkyo University School of Medicine, Tochigi, Japan.
Kyo
K
K
Yamada
Y
Y
Ito
S
S
Ando
T
T
Arisaka
O
O
D002648:Child; D002675:Child, Preschool; D016572:Cyclosporine / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D004305:Dose-Response Relationship, Drug; D005260:Female; D006801:Humans; D007166:Immunosuppressive Agents / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D007223:Infant; D007668:Kidney / Q000187:drug effects* / Q000473:pathology; D008297:Male; D009404:Nephrotic Syndrome / Q000188:drug therapy* / Q000473:pathology*; D012074:Remission Induction
D007166:Immunosuppressive Agents; D016572:Cyclosporine