Effects of cyclosporin A therapy combined with steroids and angiotensin converting enzyme inhibitors on childhood IgA nephropathy.
To evaluate the effects of cyclosporin A (CyA) on clinical outcome and pathologic changes in children with IgA nephropathy (IgAN), we retrospectively evaluated 14 children (mean age 8.9+/-2.9 yr; eight males, six females) who were treated with CyA and steroids. The starting dose of CyA was 5 mg/kg per day, and the drug level was maintained at 100-200 ng/mL. The mean CyA level was 183.8+/-48.3 ng/mL (range 120.7-276.0 ng/mL) and the mean duration of CyA therapy was 10.9+/-1.9 months (range 8-12 months). After CyA therapy the mean 24 hr urinary protein excretion declined from 107.1+/-35.1 mg/m(2)/hr to 7.4+/-2.4 mg/m(2)/hr (P<0.001) and serum albumin increased from 3.3+/-0.6 g/dL to 4.3+/-0.3 g/dL (P<0.001). At a follow-up biopsy the histological grade of IgAN was improved in seven (50%) of the 14 patients, remained the same in three (21%), and was aggravated in four (29%). Serum creatinine, creatinine clearance, and blood pressure did not differ before and after CyA therapy. Two patients (14%) showed CyA-induced nephrotoxicity at the second biopsy. Our findings indicate that CyA therapy may be effective in reducing proteinuria and regressing renal pathology in a subset of children with IgAN.
Shin
Jae Il
JI
The Institute of Kidney Disease, Department of Pediatrics, Yonsei University College of Medicine, Severance Children's Hospital, Seoul, Korea.
Lim
Beom Jin
BJ
Kim
Pyung Kil
PK
Lee
Jae Seung
JS
Jeong
Hyeon Joo
HJ
Kim
Ji Hong
JH
D000806:Angiotensin-Converting Enzyme Inhibitors / Q000008:administration & dosage*; D002648:Child; D016572:Cyclosporine / Q000008:administration & dosage*; D004338:Drug Combinations; D005260:Female; D005922:Glomerulonephritis, IGA / Q000175:diagnosis* / Q000188:drug therapy*; D006801:Humans; D007166:Immunosuppressive Agents / Q000008:administration & dosage; D008297:Male; D013256:Steroids / Q000008:administration & dosage*; D016896:Treatment Outcome
D000806:Angiotensin-Converting Enzyme Inhibitors; D004338:Drug Combinations; D007166:Immunosuppressive Agents; D013256:Steroids; D016572:Cyclosporine