Combined cyclosporine and prednisolone therapy in adult patients with the first relapse of minimal-change nephrotic syndrome.
BACKGROUND
Although minimal-change nephrotic syndrome (MCNS) is highly steroid-responsive, some patients show frequent relapses, necessitating administration of repeated courses of prednisolone (PSL) at high doses. The adverse effects of long-term PSL treatment include osteoporosis, infection, diabetes, cataract, etc., most of which are serious. It is therefore necessary to establish useful strategies to reduce the PSL dose.


METHODS
Patients with the first relapse of MCNS were randomly assigned to two groups, namely, the CyA (AUC 1700-2000 ng/ml) + PSL (0.8 mg/kg/day) group (n = 26) and the PSL alone (PSL) (1.0 mg/kg/day) group (n = 26), and the clinical characteristics were compared between the two groups. All patients used C2 for CyA monitoring.


RESULTS
A significant decrease of the urinary protein excretion (P = 0.02) and serum total cholesterol (P = 0.003) was observed at 2 weeks from the first relapse in the CyA + PSL group. The increase in the serum total protein (P = 0.03) and serum albumin (P = 0.007) as compared with that in the PSL group was also observed in the CyA + PSL group at this time-point. The time to remission in the CyA + PSL group was shorter than that in the PSL group (P = 0.006).


CONCLUSIONS
It was possible to obtain early remission and reduce the PSL dose with combined CyA and PSL therapy in patients with MCNS.
Eguchi
Aya
A
Department of Medicine, Kidney Center, Tokyo Women's Medical University, Tokyo, Japan.
Takei
Takashi
T
Yoshida
Takumi
T
Tsuchiya
Ken
K
Nitta
Kosaku
K
D000328:Adult; D002784:Cholesterol / Q000097:blood; D016572:Cyclosporine / Q000627:therapeutic use*; D004305:Dose-Response Relationship, Drug; D004359:Drug Therapy, Combination; D005260:Female; D005938:Glucocorticoids / Q000009:adverse effects / Q000627:therapeutic use*; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use*; D008297:Male; D009402:Nephrosis, Lipoid / Q000097:blood / Q000188:drug therapy* / Q000652:urine; D011239:Prednisolone / Q000009:adverse effects / Q000627:therapeutic use*; D011507:Proteinuria / Q000378:metabolism; D012008:Recurrence; D012074:Remission Induction; D016896:Treatment Outcome
D005938:Glucocorticoids; D007166:Immunosuppressive Agents; D016572:Cyclosporine; D002784:Cholesterol; D011239:Prednisolone