title: Predictive factors for ciclosporin-associated nephrotoxicity in children with minimal change nephrotic syndrome.
abstract: OBJECTIVE
  To identify the predictive factors for ciclosporin A (CyA)-associated nephrotoxicity (CAN) in children with minimal change nephrotic syndrome (MCNS).
  
  
  METHODS
  The clinical and laboratory findings of 58 children (median age 3.2 years, range 1.1-13.1 years, male:female 48:10) with MCNS who were treated with CyA from 1992 to 2002 were analysed retrospectively. Forty-eight (83%) of them were steroid dependent and 10 (17%) were steroid resistant. The starting dose of CyA was 5mg/kg per day, and the desired drug level was kept at 100-200 ng/ml. Serial renal biopsies were performed before and after CyA therapy.
  
  
  RESULTS
  Twenty-two patients (38%) had CAN (group I) and 36 (62%) did not (group II). There were no differences in the age at onset, sex, initial response to steroids, duration of CyA therapy and relapse rates. However, the median CyA trough levels were significantly higher in group I than in group II (218.0±15.2 vs 171.8±6.7 ng/ml, p=0.01). Changes in creatinine clearance were more decreased in group I than in group II (-39.4±8.2 vs 2.7±4.3 ml/min per 1.73m(2), p<0.0001). Multiple logistic regression analysis also revealed the median CyA trough level was an independent risk factor for the development of CAN (OR 1.025, 95% CI 1.007 to 1.044, p=0.007).
  
  
  CONCLUSIONS
  The median CyA trough level was an independent and significant risk factor for the development of CAN in children with MCNS receiving moderate-dose CyA.
authors: The Institute of Kidney Disease, Department of Pediatrics, Yonsei University College of Medicine, Severance Children's Hospital, Seoul, Korea.
authors: Ji Hong
authors: JH
authors: Kim
authors: Se Jin
authors: SJ
authors: Park
authors: So Jin
authors: SJ
authors: Yoon
authors: Beom Jin
authors: BJ
authors: Lim
authors: Hyeon Joo
authors: HJ
authors: Jeong
authors: Jae Seung
authors: JS
authors: Lee
authors: Pyung Kil
authors: PK
authors: Kim
authors: Jae Il
authors: JI
authors: Shin
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D016572:Cyclosporine / Q000009:adverse effects* / Q000097:blood; D005260:Female; D006801:Humans; D007166:Immunosuppressive Agents / Q000009:adverse effects* / Q000097:blood; D007223:Infant; D007674:Kidney Diseases / Q000097:blood / Q000139:chemically induced*; D008297:Male; D009402:Nephrosis, Lipoid / Q000188:drug therapy*; D012307:Risk Factors
chemical_list: D007166:Immunosuppressive Agents; D016572:Cyclosporine