Combined cyclosporine and prednisolone therapy in adult patients with the first relapse of minimal-change nephrotic syndrome

Eguchi, Aya; Takei, Takashi; Yoshida, Takemi; Tsuchiya, Ken; Nitta, Kosaku

doi:10.1093/ndt/gfp422

Cited by 38 publications

(34 citation statements)

References 16 publications

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“…GCS-dependent suppression of both cell-mediated and humoral immunity is already well established in NS [9]. On the other hand, GCS influence all types of inflammatory events, no matter what their cause.…”

Section: Introductionmentioning

confidence: 90%

“…Interestingly, GCS are indicated as an essential part of the inductive treatment in all NS patients, including subjects in whom NS is the result of something other than immune disorders [1,9]. The lack of effective response to GCS enables physicians to identify a group of patients with definitive resistance to steroids (steroid resistant NS, SRNS) and perform additional laboratory tests (i.e.…”

Section: Introductionmentioning

confidence: 99%

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SOCS3 and SOCS5 mRNA expressions may predict initial steroid response in nephrotic syndrome children

Ostalska‐Nowicka

Śmiech²,

Jaroniec³

et al. 2012

Folia Histochem Cytobiol.

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Suppressors of Cytokine Signaling (SOCS) inhibit Signal Transducers and Activators of Transcription (STATs) phosphorylation by binding and inhibiting Janus Kinases (JaKs). The aim of the present study was to evaluate the influence of glucocorticosteroids on the JaK/STAT signaling pathway in the leukocytes of nephrotic syndrome (NS) patients. The study group was composed of 34 steroid sensitive NS (SSNS) children and 20 steroid resistant NS (SRNS) subjects. Gene expression was assessed by real-time PCR using pre-designed human JaK/STAT PCR array. Protein expression was evaluated using ELISA assay (plasma concentration) and immunofluorescence (in situ protein expression). In SSNS children, the initial increased expression of JaK1, JaK2, JaK3, STAT1, STAT2, STAT6, TYK2, SOCS1, SOCS2, SOCS3, SOCS4 and SOCS5 was reduced back to the control limits. Similarly, in SRNS patients the increased levels of almost all mRNA expressions for the abovementioned genes were decreased, with the exceptions of SOCS3 and SOCS5 expressions. These mRNA expressions were still significantly increased and correlated with early unfavorable course of nephrotic syndrome in children. Plasma levels of SOCS3, SOCS5, IL-6 and IL-20 were significantly increased in SRNS subjects after six weeks of steroids medication compared to SSNS and control participants. We conclude that SOCS3 and SOCS5 increased mRNA expressions might predict initial resistance

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Section: Introductionmentioning

confidence: 90%

Section: Introductionmentioning

confidence: 99%

SOCS3 and SOCS5 mRNA expressions may predict initial steroid response in nephrotic syndrome children

Ostalska‐Nowicka

Śmiech²,

Jaroniec³

et al. 2012

Folia Histochem Cytobiol.

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“…In a randomized controlled trial by Ponticelli et al on 75 adults and children with frequently relapsing NS and steroid-dependent NS (31 were MCD), long-term outcome was better with cyclophosphamide versus CsA, with 63% patients maintaining remission after 2 years compared with 25% with CsA (68). On the other hand, adding CsA to steroids was found to induce remission more rapidly than steroids alone at first relapse (69). The optimal CsA dose is not established, however, KDIGO guidelines suggest a 3-5 mg/kg per day range on the basis of dosages used in these studies.…”

Section: Adultsmentioning

confidence: 99%

Minimal Change Disease

Vivarelli

Massella

Ruggiero

et al. 2016

CJASN

396

383

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Minimal change disease (MCD) is a major cause of idiopathic nephrotic syndrome (NS), characterized by intense proteinuria leading to edema and intravascular volume depletion. In adults, it accounts for approximately 15% of patients with idiopathic NS, reaching a much higher percentage at younger ages, up to 70%-90% in children >1 year of age. In the pediatric setting, a renal biopsy is usually not performed if presentation is typical and the patient responds to therapy with oral prednisone at conventional doses. Therefore, in this setting steroid-sensitive NS can be considered synonymous with MCD. The pathologic hallmark of disease is absence of visible alterations by light microscopy and effacement of foot processes by electron microscopy. Although the cause is unknown and it is likely that different subgroups of disease recognize a different pathogenesis, immunologic dysregulation and modifications of the podocyte are thought to synergize in altering the integrity of the glomerular basement membrane and therefore determining proteinuria. The mainstay of therapy is prednisone, but steroid-sensitive forms frequently relapse and this leads to a percentage of patients requiring second-line steroid-sparing immunosuppression. The outcome is variable, but forms of MCD that respond to steroids usually do not lead to chronic renal damage, whereas forms that are unresponsive to steroids may subsequently reveal themselves as FSGS. However, in a substantial number of patients the disease is recurrent and requires long-term immunosuppression, with significant morbidity because of side effects. Recent therapeutic advances, such as the use of anti-CD20 antibodies, have provided long-term remission off-therapy and suggest new hypotheses for disease pathogenesis.

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“…24 A course of corticosteroids is usually administered for the first relapse, although there are no trials to support this practice. Eguchi et al 45 randomized 52 MCD adults with their first relapse to cyclosporine (area under the curve=1700-2000 ng/ml) plus prednisolone (0.8 mg/kg per day) or prednisolone monotherapy (1 mg/kg per day). Remission was achieved sooner in the cyclosporine group, with the possible additional benefit of lower exposure to steroids.…”

Section: Relapse Of MCDmentioning

confidence: 99%

The Treatment of Minimal Change Disease in Adults

Hogan

Radhakrishnan

2013

Journal of the American Society of Nephrology

128

123

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Minimal change disease (MCD) is the etiology of 10%-25% of cases of nephrotic syndrome in adults. The mainstay of treatment for adult MCD, oral gucocorticoids, is based on two randomized controlled trials and extensive observational data in adults, and this treatment leads to remission in over 80% of cases. Relapses are common, and some patients become steroid-resistant (SR), steroid-dependent (SD), or frequently relapsing (FR). The data guiding the treatment of these patients are limited. Here, we review MCD in adults with particular focus on the evidence for immunosuppressive therapy in these patients.

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Combined cyclosporine and prednisolone therapy in adult patients with the first relapse of minimal-change nephrotic syndrome

Abstract: It was possible to obtain early remission and reduce the PSL dose with combined CyA and PSL therapy in patients with MCNS.

Cited by 38 publications

References 16 publications

SOCS3 and SOCS5 mRNA expressions may predict initial steroid response in nephrotic syndrome children

SOCS3 and SOCS5 mRNA expressions may predict initial steroid response in nephrotic syndrome children

Minimal Change Disease

The Treatment of Minimal Change Disease in Adults

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