title: Effectiveness of high trough levels of cyclosporine for 5 months in a case of steroid-dependent nephrotic syndrome with severe steroid toxicity.
abstract: Glucocorticoid treatment for steroid-dependent nephrotic syndrome (NS) is associated with severe adverse effects, such as bone fractures and epidural lipomatosis. Furthermore, a high trough level of cyclosporine (CsA) over an extended period of time is known to induce CsA nephropathy. We present a girl with steroid-dependent NS and steroid-induced vertebral compression fractures and epidural lipomatosis who was treated with a high-dose of prednisolone after experiencing several relapses. A high CsA trough level (between 147 and 225 ng/mL) over a period of only 5 months was effective in improving the vertebral compression fractures, alleviating the epidural lipomatosis by enabling the discontinuation of prednisolone treatment. Thus, high trough levels of CsA over a short period of time may enable prednisolone to be discontinued in cases of steroid-dependent NS without causing any clinical, histological, serum and/or urinary CsA-related adverse effects.
authors.affiliation: Department of Pediatrics, Dokkyo University School of Medicine, Tochigi, Japan. k-kano@dokkyomed.ac.jp
authors.forename: Kenichi
authors.initials: K
authors.lastname: Kano
authors.forename: Yumi
authors.initials: Y
authors.lastname: Yamada
authors.forename: Taeko
authors.initials: T
authors.lastname: Shiraiwa
authors.forename: Aki
authors.initials: A
authors.lastname: Shimizu
authors.forename: Kiyoshi
authors.initials: K
authors.lastname: Nishikura
authors.forename: Osamu
authors.initials: O
authors.lastname: Arisaka
authors.forename: Shigeki
authors.initials: S
authors.lastname: Tomita
authors.forename: Yoshihiko
authors.initials: Y
authors.lastname: Ueda
mesh_terms: D002675:Child, Preschool; D016572:Cyclosporine / Q000008:administration & dosage* / Q000009:adverse effects / Q000493:pharmacokinetics; D005260:Female; D005938:Glucocorticoids / Q000009:adverse effects / Q000627:therapeutic use*; D006801:Humans; D008068:Lipomatosis / Q000139:chemically induced; D009404:Nephrotic Syndrome / Q000188:drug therapy*; D011239:Prednisolone / Q000009:adverse effects / Q000627:therapeutic use*; D013122:Spinal Diseases / Q000139:chemically induced; D016103:Spinal Fractures / Q000139:chemically induced
chemical_list: D005938:Glucocorticoids; D016572:Cyclosporine; D011239:Prednisolone