Cyclosporine-A-induced nephrotoxicity in children with minimal-change nephrotic syndrome: long-term treatment up to 10 years.
The impact of cyclosporine A (CsA) therapy in patients with steroid-dependent nephrotic-syndrome (SDNS) on long-term renal function is controversial. Data beyond 5 years are rare. Long-term renal function was evaluated in children with SDNS with and without CsA therapy, especially beyond 5 years. Twenty children were treated with CsA (study group) for a mean of 5.4 +/- 2.2 years (ten patients for 5-11 years). Glomerular filtration rate (GFR) was calculated before and after 3 and 12 months and at latest follow-up of therapy. Fifteen children with cyclophosphamide-treated SDNS without CsA served as controls. In the study group, GFR decreased within 12 months from 136 +/- 19 to 120 +/- 31, to 114 +/- 14 ml/min per 1.73 m(2) at latest follow-up (p < 0.0001). Patients with CsA > 5 years had a GFR of 111 +/- 14 ml/min per 1.73 m(2) at latest follow-up without a GFR below 90 ml/min per 1.73 m(2). No CsA toxicity was found in biopsies. In the control group, GFR dropped within 3 months, from 137 +/- 27 to 130 +/- 24, to 126 +/- 19 ml/min per 1.73 m(2) at latest follow-up (p = 0.1). Patients with and without nephrotoxic CsA therapy showed a drop in GFR. In CsA-treated patients, GFR was about 12% lower at latest follow-up compared with patients without nephrotoxic therapy but always remained within normal range. CsA seems to be safe, even in long-term treatment for more than 5 years.
Kranz
Birgitta
B
Clinic of Pediatric Nephrology, University Clinic Essen, Essen, Germany. annett-birgitta.kranz@uk-essen.de
Vester
Udo
U
Büscher
Rainer
R
Wingen
Anne-Margret
AM
Hoyer
Peter F
PF
D002648:Child; D002675:Child, Preschool; D003520:Cyclophosphamide / Q000627:therapeutic use; D016572:Cyclosporine / Q000009:adverse effects*; D005260:Female; D005919:Glomerular Filtration Rate / Q000187:drug effects*; D006801:Humans; D007166:Immunosuppressive Agents / Q000009:adverse effects*; D007668:Kidney / Q000187:drug effects* / Q000503:physiopathology; D007674:Kidney Diseases / Q000139:chemically induced* / Q000503:physiopathology; D008297:Male; D009402:Nephrosis, Lipoid / Q000150:complications / Q000188:drug therapy*
D007166:Immunosuppressive Agents; D016572:Cyclosporine; D003520:Cyclophosphamide