title: Cyclosporine A for the treatment of refractory nephrotic syndrome with renal dysfunction.
abstract: Cyclosporine A (CsA) is an immunosuppressant agent and is utilized as a second-line drug therapy for refractory nephrotic syndrome (RNS). In general, the use of CsA is strictly controlled in patients with an estimated glomerular filtration rate (eGFR) <30-40 ml/min/1.73 m2, and little is known about the safety and efficacy of CsA treatment in patients with RNS complicated by renal dysfunction. In the present study, the clinical data of 10 patients with RNS and renal dysfunction, who received CsA treatment between 2000 and 2009 in the Kidney Institute of PLA, were reviewed retrospectively. Pathologically, these patients included six cases with minimal change, two cases of diffuse mesangial proliferation and two cases of focal segmental glomerulosclerosis. Six months subsequent to the initiation of the CsA treatment, six patients achieved complete remission, two patients achieved remarkable remission and two patients achieved partial remission. Renal function was improved in all patients as represented by the improvement in the eGFR (28.6±3.8 ml/min/1.73 m2prior to treatment versus 99.3±21.9 ml/min/1.73 m26 months subsequent to treatment). Few adverse CsA-related events were observed. These results suggest that renal dysfunction is not an absolute contraindication for CsA treatment in patients with RNS. The use of CsA is safe and efficacious and may, in certain cases, improve renal function in patients with RNS and renal impairment.
authors.affiliation: Department of Medicine, Kidney Institute of PLA, Changzheng Hospital, Second Military Medical University, Shanghai 200003, P.R. China.
authors.forename: Xiang
authors.initials: X
authors.lastname: Gao
authors.affiliation: Department of Medicine, Kidney Institute of PLA, Changzheng Hospital, Second Military Medical University, Shanghai 200003, P.R. China.
authors.forename: Yiyi
authors.initials: Y
authors.lastname: Ma
authors.affiliation: Department of Medicine, Kidney Institute of PLA, Changzheng Hospital, Second Military Medical University, Shanghai 200003, P.R. China.
authors.forename: Lijun
authors.initials: L
authors.lastname: Sun
authors.affiliation: Department of Medicine, Kidney Institute of PLA, Changzheng Hospital, Second Military Medical University, Shanghai 200003, P.R. China.
authors.forename: Dongping
authors.initials: D
authors.lastname: Chen
authors.affiliation: Department of Medicine, Kidney Institute of PLA, Changzheng Hospital, Second Military Medical University, Shanghai 200003, P.R. China.
authors.forename: Changlin
authors.initials: C
authors.lastname: Mei
authors.affiliation: Department of Medicine, Kidney Institute of PLA, Changzheng Hospital, Second Military Medical University, Shanghai 200003, P.R. China.
authors.forename: Chenggang
authors.initials: C
authors.lastname: Xu
keywords: cyclosporine A; refractory nephrotic syndrome; renal dysfunction; therapy