title: Treatment of steroid-resistant nephrotic syndrome with cyclosporine: study of 17 cases and a literature review.
abstract: BACKGROUND
  Cyclosporine (CsA) has been used in steroid-resistant idiopathic nephrotic syndrome (INS) in many previous studies.
  
  
  OBJECTIVE
  To evaluate if CsA is a therapeutic option for steroid-resistant nephrotic syndrome.
  
  
  METHODS
  We performed a retrospective cohort study to evaluate the effects of CsA in 17 steroid-resistant INS patients. The main laboratorial data, before and after the use of CsA, and the response to CsA were evaluated. A literature review on this subject was also done.
  
  
  RESULTS
  Patient age ranged from 2-43 yrs. Pre-treatment renal biopsy demonstrated focal segmental glomerulosclerosis (FSGS) (64%), membranous nephropathy (MGN) (12%), mesangial glomerulonephritis (MSGN) (12%) and minimal change disease (MCD) (12%). Pre-treatment laboratory tests showed a mean 24-hr proteinuria of 4372 +/- 2686 mg/dL. Treatment with CsA was given for a minimum of 3 months and a maximum of 98 months. Mean 24-hr proteinuria declined from 3181 +/- 2277 before CsA to 915 +/- 1140 mg/24 hr after CsA (p<0.001). Remission was seen in 70.5% of patients, being 52.9% complete and 17.6% partial. The adverse effects observed were nephrotoxicity (11.7%), hypertrichosis (5.8%) and gingival hyperplasia (5.8%). Relapses were seen in eight patients (47%), with posterior remission in six patients (75%).
  
  
  CONCLUSIONS
  Data from the literature suggest that CsA is a good therapeutic option for patients with steroid-resistant INS, being effective in reducing proteinuria. The beneficial effect of CsA demonstrated in our study was limited due to its design and the small sample size.
authors.affiliation: Division of Nephrology, School of Medicine, Walter Cantidio University Hospital, Federal University of Ceará, Fortaleza, Ceará - Brazil. paulafernandes@fortalnet.com.br
authors.forename: Paula
authors.initials: P
authors.lastname: Frassinetti Castelo Branco Camurça Fernandes
authors.forename: Geraldo
authors.initials: G
authors.lastname: Bezerra Da Silva
authors.forename: Fernando A
authors.initials: FA
authors.lastname: De Sousa Barros
authors.forename: Claudia M
authors.initials: CM
authors.lastname: Costa Oliveira
authors.forename: Marcos
authors.initials: M
authors.lastname: Kubrusly
authors.forename: João B
authors.initials: JB
authors.lastname: Evangelista
mesh_terms: D000293:Adolescent; D000328:Adult; D001706:Biopsy; D002648:Child; D002675:Child, Preschool; D003404:Creatinine / Q000097:blood; D016572:Cyclosporine / Q000627:therapeutic use*; D018450:Disease Progression; D004351:Drug Resistance; D005260:Female; D005500:Follow-Up Studies; D005938:Glucocorticoids / Q000627:therapeutic use*; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use*; D008297:Male; D009404:Nephrotic Syndrome / Q000097:blood / Q000188:drug therapy* / Q000473:pathology; D012008:Recurrence; D012074:Remission Induction; D012189:Retrospective Studies; D016896:Treatment Outcome
chemical_list: D005938:Glucocorticoids; D007166:Immunosuppressive Agents; D016572:Cyclosporine; D003404:Creatinine