Serum creatinine in cyclosporin-induced remission of steroid-resistant nephrotic syndrome

Miller, Carlos O.; Feutren, G.; Schiess, William A.; Graffenried, B. von

doi:10.1016/0140-6736(90)91238-6

Cited by 6 publications

(2 citation statements)

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“…There are conflicting data regarding the effectiveness of CsA therapy for the treatment of recurrent FSGS. CsA therapy has been reported to be effective in reducing the proteinuria in children with FSGS [6] and inhibiting the proteinuric effects of the FSGS factor [14,15]. However, Ingulli and Tejani [16] concluded that there was no proven advantage in adding CsA to the treatment of pediatric renal transplant recipients with recurrent FSGS.…”

Section: Discussionmentioning

confidence: 99%

“…Because of the high rate of graft loss, some investigators have concluded that living-related donor transplantation should be discouraged [3], while others have utilized plasmapheresis [4], protein A immunoadsorption [5], and immunosuppressive drugs [6] to control recurrent FSGS in the early post-transplant period. Most of the previous reports described plasmapheresis and immunosuppressive drug treatments during the 1st month post transplant.…”

Section: Introductionmentioning

confidence: 99%

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Long-term plasmapheresis and protein A column treatment of recurrent FSGS

Belson

Yorgin

Al‐Uzri

et al. 2001

Pediatric Nephrology

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Transient or intermittent plasmapheresis with concurrent immunosuppressive therapy is thought to be beneficial in the treatment of recurrent focal segmental glomerulosclerosis (FSGS) in the early post-transplant period. The results of long-term (6-year) plasmapheresis therapy, in a 9-year-old female with an immediate recurrence of FSGS [urinary protein/urinary creatinine (UP/UC)=17.7] after cadaveric renal transplant, are presented. A 4-week plasmapheresis course induced a decline in the proteinuria, but a relapse occurred after cessation of plasmapheresis. Addition of protein A column therapy led to a further decrease in the proteinuria, to a non-nephrotic range. Long-term control of the nephrotic syndrome was established using a chronic treatment regimen consisting of a single-volume plasmapheresis, followed by a protein A column treatment, performed on sequential days every 3-4 weeks. Mean UP/UC values decreased to 1.15+/-0.9. A course of cyclophosphamide was successfully used to control a worsening of proteinuria 4 years post transplant. Although sequential renal biopsies demonstrated progressive glomerular sclerosis, the patient's mean calculated creatinine clearance only modestly declined from 78.3 ml/min per 1.73 m2, at the time of transplantation, to 62.7 ml/min per 1.73 m2, 6 years later. This patient demonstrated dependence on plasmapheresis/protein A column therapy to maintain a clinical remission of her FSGS recurrence. While long-term plasmapheresis and protein A column therapy in combination with immunosuppressive therapy reversed the effects of uncontrolled nephrosis and possibly facilitated long-term renal allograft survival, the glomerular sclerosis continued to progress.

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