Treatment of the nephrotic syndrome with cyclosporin A

Ponticelli, Claudio

doi:10.1016/0896-8411(92)90049-v

Cited by 10 publications

(1 citation statement)

References 29 publications

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“…It has been reported to be highly effective in the management of patients with steroid-dependent nephrotic syndrome (70%-100% response rate), but somewhat less effective in those with steroid-resistant nephrotic syndrome (0%-100% response rate) [1][2][3][4][5][6][7][8][9][10]. The response to CsA in both adult and pediatric studies has also been reported to correlate with initial renal histology, with patients with minimal change nephrotic syndrome (MCNS) on renal biopsy having a better response than those with focal segmental glomerulosclerosis (FSGS) [11][12][13][14][15][16][17].…”

Section: Introductionmentioning

confidence: 97%

Quantitative morphometry of renal biopsies prior to cyclosporine in nephrotic syndrome

Smoyer

Gregory

Bajwa

et al. 1998

Pediatric Nephrology

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Use of cyclosporine (CsA) in the management of children with steroid-resistant (SRNS) and steroid-dependent (SDNS) nephrotic syndrome has become increasingly popular in recent years. Although most children receive a renal biopsy prior to initiation of CsA, the relationship between initial renal histology and the subsequent clinical response to CsA is not known. We analyzed the correlation between pre-CsA segmental and global glomerular scarring and interstitial fibrosis and the subsequent response to CsA in 23 children (5.6+/-1.0 years, Mean+/-SEM) with SDNS (n=8) and SRNS (n=15) treated with CsA for 24.2+/-3.8 months and followed for 28.0+/-4.1 months. Complete remission was obtained in 78% of patients within 67.6+/-16 days, while 18% had a partial response and 4% no response. Quantitative histological analysis revealed a trend toward partial rather than complete response with increasing segmental glomerular (P=0.13), global glomerular (P=0.05), and interstitial (P=0.08) scarring, and among patients with minimal change nephrotic syndrome versus IgM nephropathy versus focal segmental glomerulosclerosis. Among complete responders, linear regression analyses revealed no correlation between time to response and pre-CsA glomerular or interstitial scarring. We conclude that increased glomerular or interstitial scarring on a pre-CsA renal biopsy tends to correlate with a partial, rather than complete, response to CsA in childhood nephrotic syndrome.

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