title: Clinical evaluation of chronic nephrotoxicity of long-term cyclosporine A treatment in adult patients with steroid-dependent nephrotic syndrome.
abstract: OBJECTIVE
  Chronic nephrotoxicity of long-term cyclosporine A (CsA) treatment is a matter of concern in patients with steroid-dependent nephrotic syndrome (SDNS).
  
  
  METHODS
  Twenty-eight adult NS patients (25, minimal-change nephrotic syndrome (NS); three, focal-segmental glomerulosclerosis) were divided into three groups. Group A was continuously treated with CsA for more than 5 years (143 ± 40 months, 1.3 ± 0.4 mg/kg per day at final analysis, n = 12); group B had been previously treated with CsA (70 ± 27 months, n = 6); and group C had been treated with corticosteroids alone (n = 10). The clinical variables related to chronic CsA nephrotoxicity were examined.
  
  
  RESULTS
  In groups A and B, estimated glomerular filtration rate decreased from 86 ± 22 and 107 ± 17 to 83 ± 23 and 88 ± 13 mL/min per 1.73 m(2) , respectively, at final analysis (both P < 0.05). Serum magnesium levels in group A were significantly lower than those in group B or C (A, 1.78 ± 0.16 mg/dL; B, 2.00 ± 0.14 mg/dL; C, 2.03 ± 0.10 mg/dL; A vs B, C, P < 0.01), and a significant correlation between these and the duration of CsA treatment was found (r = -0.68, P < 0.001). There was a trend towards a correlation between the duration of CsA administration and urinary α1-microglobulin (r = 0.38, P = 0.07).
  
  
  CONCLUSIONS
  Mild decrease in renal function and hypomagnesemia were found in adult SDNS patients with long-term CsA treatment. Careful monitoring of renal function, blood pressure and serum magnesium levels is necessary.
authors.affiliation: Department of Nephrology, Tokyo Medical University, Tokyo, Japan. t-okada@tokyo-med.ac.jp
authors.forename: Tomonari
authors.initials: T
authors.lastname: Okada
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Matsumoto
authors.forename: Yume
authors.initials: Y
authors.lastname: Nagaoka
authors.forename: Ryo
authors.initials: R
authors.lastname: Tomaru
authors.forename: Hideaki
authors.initials: H
authors.lastname: Iwasawa
authors.forename: Toshikazu
authors.initials: T
authors.lastname: Wada
authors.forename: Toshiyuki
authors.initials: T
authors.lastname: Nakao
mesh_terms: D000293:Adolescent; D000305:Adrenal Cortex Hormones / Q000008:administration & dosage*; D000328:Adult; D000368:Aged; D000704:Analysis of Variance; D015415:Biomarkers / Q000097:blood; D001794:Blood Pressure / Q000187:drug effects; D016572:Cyclosporine / Q000008:administration & dosage / Q000009:adverse effects*; D004334:Drug Administration Schedule; D005260:Female; D005919:Glomerular Filtration Rate / Q000187:drug effects; D005923:Glomerulosclerosis, Focal Segmental / Q000097:blood / Q000188:drug therapy* / Q000503:physiopathology; D006801:Humans; D007564:Japan; D007668:Kidney / Q000187:drug effects* / Q000378:metabolism / Q000503:physiopathology; D008274:Magnesium / Q000097:blood; D008297:Male; D008875:Middle Aged; D009404:Nephrotic Syndrome / Q000097:blood / Q000188:drug therapy* / Q000503:physiopathology; D012008:Recurrence; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D000305:Adrenal Cortex Hormones; D015415:Biomarkers; D016572:Cyclosporine; D008274:Magnesium