[Combined effect of cyclosporin and prednisolone for minimal change nephrotic syndrome: comparison with prednisolone therapy].
BACKGROUND
Minimal change nephrotic syndrome (MCNS) is the most common type of glomerular disease and treated mainly with corticosteroids, usually prednisolone(PSL). The recurrence rate during PSL treatment is approximately 20-30 %. In addition, the adverse effects of long term PSL treatment include diabetes, osteoporosis, infection etc, most of which are serious. We treated MCNS with PSL and cyclosporin (CyA) as an initial therapy to reduce PSL dosage and its side effects, and compared various clinical parameters in MCNS treated with the conventional PSL therapy.


METHODS
MCNS patients were divided to two groups. Group A consisted of 10 patients, average age 40 years old, treated initially with PSL 20 mg and CyA (2 mg/kg B.W.). Group B consisted 15 patients, average age 43 years old, treated PSL, initial dose 34.7+/-11.9 mg. Data evaluated included whole admission term, reduction of body weight at the discharge, total PSL dosage, period of urinary protein excretion more than 1.0 g/day and side effects.


RESULTS
Average admission term was significantly shorter in Group A(19.3+/-8.8 days) than in Group B (56.5+/-22.3 days) (p= 0.0008). Reduction of body weight at discharge from admission was comparable in both Groups (A: 8.3+/-4.8 kg, B: 7.8+/-5.8 kg, p=0.8388). Total PSL dosage in Group A in hospital (386+/-173 mg) was smaller than in Group B (1,884+/-1,573 mg) (p=0.0067). PSL dosage out hospital for 6 months showed the same results A: 1,926+/-776 mg, B: 15,474+/-3,863 mg (p<0.0001). Periods with urinary protein excretion more than 1.0 g/day was slightly shorter in Group A (12.9+/-8.4 days) than Group B (23.7+/-18.3 days) (p= 0.0963).


RESULTS
One patient in Group B had steroid induced diabetes. Other patients did not show significant side effects. RECURRENCE: Two patients in Group A had recurrence after CyA stopped, but were improved by treatment.


CONCLUSIONS
Initial therapy with PSL and CyA for MCNS is effective for the resolution of nephrotic syndrome, the reduction of PSL amount and whole admission term.
Hayashi
Masanori
M
Department of Internal Medicine, Fukui Red Cross Hospital, Fukui, Japan.
Kimura
Noriyo
N
Fukatsu
Atsushi
A