Intravenous cyclosporine therapy in recurrent nephrotic syndrome after renal transplantation in children.
BACKGROUND
Early recurrence of massive proteinuria after renal transplantation occurs in 20% to 30% of patients with steroid-resistant idiopathic nephrotic syndrome and is responsible for graft failure in approximately half of cases. We report our experience with the use of intravenous (IV) cyclosporine (CsA) in children with recurrent proteinuria after renal transplantation.


METHODS
Between March 1991 and August 2001, 36 renal transplantations were performed in 35 patients with steroid-resistant idiopathic nephrotic syndrome in our institution. Recurrence, defined by proteinuria higher than 50 mg/kg per day in the absence of acute rejection or urinary tract infection, was observed in 17 grafts performed in 16 patients. In patients with recurrence, CsA was administered IV, at an initial dose of 3 mg/kg per day, which was afterward adapted to maintain whole-blood levels between 250 and 350 ng/mL.


RESULTS
In 14 of 17 cases (82%) with recurrence, proteinuria completely disappeared after 20.8+/-8.4 (range 12-40) days. The treatment was ineffective in the remaining three patients with persistent proteinuria at the end of the second month posttransplantation. Plasma exchanges were performed in four patients during the first 2 months, and proteinuria regressed in three cases and persisted in one. Persistent remission was observed in 11 patients with a follow-up of 3.7+/-3 (range 0.3-9) years. Actuarial graft survival was 92% and 70% at 1 and 5 years.


CONCLUSIONS
IV CsA is a safe and effective treatment in children with recurrent nephrotic syndrome after renal transplantation.
Salomon
Rémi
R
Service de Néphrologie Pédiatrique, Hôpital Necker-Enfants Malades, 75743 Paris Cedex 15, France.
Gagnadoux
Marie-France
MF
Niaudet
Patrick
P
D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D016572:Cyclosporine / Q000008:administration & dosage*; D005500:Follow-Up Studies; D006084:Graft Rejection / Q000188:drug therapy; D006801:Humans; D007166:Immunosuppressive Agents / Q000008:administration & dosage*; D007275:Injections, Intravenous; D007676:Kidney Failure, Chronic / Q000473:pathology / Q000601:surgery; D016030:Kidney Transplantation; D009404:Nephrotic Syndrome / Q000188:drug therapy* / Q000473:pathology; D011183:Postoperative Complications / Q000188:drug therapy / Q000473:pathology; D011446:Prospective Studies; D011507:Proteinuria / Q000188:drug therapy / Q000473:pathology; D012008:Recurrence; D013997:Time Factors; D016896:Treatment Outcome
D007166:Immunosuppressive Agents; D016572:Cyclosporine