title: Combination treatment with corticosteroid, cyclosporine A, and mycophenolate in refractory nephrotic syndrome.
abstract: OBJECTIVE
  Refractory nephrotic syndrome (NS) is problematic because the optimal therapy for this disease is unclear and because persistent NS progresses eventually to end-stage renal disease. We report our experience using a combination of corticosteroid, cyclosporine A (CsA), and mycophenolate mofetil (MMF) to treat 10 refractory NS patients.
  
  
  METHODS
  Ten refractory NS patients, who showed resistance to corticosteroid and CsA, were treated with triple immunosuppressive therapy. Cyclophosphamide and MMF had been used previously in 6 patients, but had failed to induce remission.
  
  
  RESULTS
  Triple immunosuppressive therapy was discontinued after 4 months in 1 patient because of progressive azotemia. Partial remission was achieved in 9 of the 10 patients after 10 months, and remission was maintained during the treatment (urine protein to creatinine ratio, mg/mg, baseline vs. 12th month; 5.7 ± 1.8 vs. 1.4 ± 0.7). Renal function was preserved in these 9 patients (estimated GFR, ml/min/1.73 m2, baseline vs. 12th month; 71.4 ± 29.1 vs. 68.9 ± 31.5). Of the 7 patients who discontinued triple immunosuppressive therapy, remission and renal function were maintained in 4 patients.
  
  
  CONCLUSIONS
  Triple immunosuppressive therapy significantly reduced proteinuria and preserved renal function in refractory NS patients, indicating a promising role of this therapy for refractory NS.
authors: Nephrology Division, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
authors: H R
authors: HR
authors: Jang
authors: H W
authors: HW
authors: Jung
authors: Y-J
authors: YJ
authors: Lee
authors: J E
authors: JE
authors: Lee
authors: W
authors: W
authors: Huh
authors: D J
authors: DJ
authors: Kim
authors: H Y
authors: HY
authors: Oh
authors: Y-G
authors: YG
authors: Kim