Long-term Treatment of Minimal-change Nephrotic Syndrome with Cyclosporin: A Control Biopsy Study

Clasen, W.; Kindler, Jochen; Mihatsch, Michael J.; Sieberth, Heinz–Günter

doi:10.1093/oxfordjournals.ndt.a091746

Nephrology Dialysis Transplantation

1988

DOI: 10.1093/oxfordjournals.ndt.a091746

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Long-term Treatment of Minimal-change Nephrotic Syndrome with Cyclosporin: A Control Biopsy Study

W. Clasen¹,

Jochen Kindler²,

Michael J. Mihatsch

et al.

Abstract: Abstract. Seven patients with minimal-change nephrotic syndrome confirmed by renal biopsy were treated with cyclosporin (CsA). Four patients had frequent relapses and three others had primary steroid resistant nephrotic syndrome. Corticosteroids were discontinued as soon as CsA whole blood trough values of 200-500 ng/ml (RIA method) were reached. A full remission, defined as complete disappearance of proteinuria, was achieved in five patients under this treatment. In the two other patients proteinuria was redu… Show more

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The treatment of minimal change nephrotic syndrome: Lessons learned from multicentre co-operative studies

Brodehl

1991

Eur J Pediatr

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Minimal change nephrotic syndrome (MCNS) is the most frequent type of nephrotic syndrome in childhood. Treatment aims to induce remission, prevent relapses and avoid side-effects. MCNS is responsive to immunosuppressive therapy with glucocorticosteroids, alkylating drugs and cyclosporine A. From results of multicentre controlled studies it became evident that the initial treatment with prednisone should be intensive, i.e. for 12 weeks, in order to reduce the risk of subsequent relapses. Treatment of relapses should be standardized in order to categorize the patient's disease for further treatment. In case "frequent relapsers" develop signs of steroid-toxicity, they should be treated with alkylating drugs: frequent relapsers without steroid dependency with cyclophosphamide or chlorambucil for 8 weeks, steroid-dependent cases with cyclophosphamide for 12 weeks. If frequent relapses re-occur after cytotoxic drug therapy, treatment with cyclosporine A should be considered. Starting dose is 100-150 mg/m2 per day and needs to be adjusted to the whole blood trough level. Treatment with cyclosporine A must be strictly controlled in order to avoid chronic nephrotoxicity. Cyclosporine A does not cure MCNS. It is only effective as long as it is administered; therefore long-lasting treatment is necessary in most cases.

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The treatment of minimal change nephrotic syndrome: Lessons learned from multicentre co-operative studies

Brodehl

1991

Eur J Pediatr

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The use of cyclosporin a in adult nephrotic syndrome: Nine cases and literature review

et al. 1990

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Nine adult patients with resistant nephrotic syndrome were treated with cyclosporin A (CyA). All had failed to respond to high dose corticosteroids with or without cyclophosphamide. Three patients had minimal change disease, 3 had focal sclerosing glomerulosclerosis (FSGS), 2 had mesangiocapillary GN, and one had membranous nephropathy. The mean age of the patients was 26.4 years (range 16 to 39 years). CyA was given orally twice daily at a mean dose of 6.7 mg/kg/24 hours (range 6-10 mg/kg/24 hours). Four patients achieved full remission, two patients went into partial remission and three failed to respond. Two patients developed clinical nephrotoxicity, which reversed on dose reduction or cessation of CyA. All 3 patients with minimal change disease who responded subsequently relapsed after stopping CyA, but remitted rapidly on reintroduction of the drug. We suggest that the mode of action of CyA in nephrotic syndrome may be related to intra-renal vasoconstriction in addition to its direct immunosuppressive effect. In this limited series, we found that CyA can be an effective therapy for otherwise refractory nephrotic syndrome, although relapse on withdrawal of CyA may well be a significant clinical problem.

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Erratum to: Cyclosporin: A Review of its Pharmacodynamic and Pharmacokinetic Properties, and Therapeutic Use in Immunoregulatory Disorders

Faulds¹,

Goa²,

Benfield³

1993

Drugs

285

321

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Long-term Treatment of Minimal-change Nephrotic Syndrome with Cyclosporin: A Control Biopsy Study

Cited by 10 publications

References 10 publications

The treatment of minimal change nephrotic syndrome: Lessons learned from multicentre co-operative studies

The treatment of minimal change nephrotic syndrome: Lessons learned from multicentre co-operative studies

The use of cyclosporin a in adult nephrotic syndrome: Nine cases and literature review

Erratum to: Cyclosporin: A Review of its Pharmacodynamic and Pharmacokinetic Properties, and Therapeutic Use in Immunoregulatory Disorders

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