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Pediatr Nephrol (2008) 23:581586 DOI 10.1007/s00467-007-0709-6
ORIGINAL ARTICLE
Cyclosporine-A-induced nephrotoxicity in children with minimal-change nephrotic syndrome: long-term treatment up to 10 years
Birgitta Kranz & Udo Vester & Rainer Bscher &
Anne-Margret Wingen & Peter F. Hoyer
Received: 17 May 2007 / Revised: 3 November 2007 / Accepted: 6 November 2007 / Published online: 16 January 2008 # IPNA 2007
Abstract The impact of cyclosporine A (CsA) therapy in patients with steroid-dependent nephrotic-syndrome (SDNS) on long-term renal function is controversial. Data beyond 5 years are rare. Long-term renal function was evaluated in children with SDNS with and without CsA therapy, especially beyond 5 years. Twenty children were treated with CsA (study group) for a mean of 5.42.2 years (ten patients for 511 years). Glomerular filtration rate (GFR) was calculated before and after 3 and 12 months and at latest follow-up of therapy. Fifteen children with cyclophosphamide-treated SDNS without CsA served as controls. In the study group, GFR decreased within 12 months from 13619 to 12031, to 11414 ml/min per 1.73 m2 at latest follow-up (p<0.0001). Patients with CsA>5 years had a GFR of 11114 ml/min per 1.73 m2 at
latest follow-up without a GFR below 90 ml/min per1.73 m2. No CsA toxicity was found in biopsies. In the control group, GFR dropped within 3 months, from 137 27 to 13024, to 12619 ml/min per 1.73 m2 at latest follow-up (p=0.1). Patients with and without nephrotoxic CsA therapy showed a drop in GFR. In CsA-treated patients, GFR was about 12% lower at latest follow-up compared with patients without nephrotoxic therapy but always remained within normal range. CsA seems to be safe, even in long-term treatment for more than 5 years.
Keywords Minimal-change nephrotic syndrome . Cyclosporine A . Long-term outcome . Nephrotoxicity . Glomerular filtration rate
Abbreviations SDNS steroid-dependent nephrotic syndrome IRNS infrequent relapsing nephrotic syndrome FRNS frequent relapsing nephrotic syndrome SRNS steroid-resistant nephrotic syndrome SSNS steroid-sensitive nephrotic syndrome FSGS focal segmental glomerulosclerosis MCNS minimal-change nephrotic syndrome CsA cyclosporine A CP cyclophosphamide GFR glomerular filtration rate
Introduction
Minimal-change nephrotic syndrome (MCNS) in children is characterised by steroid responsiveness, subsequent relapses and a benign prognosis concerning renal function [1]. Patients with steroid-dependent nephrotic syndrome (SDNS) and frequent relapsing nephrotic syndrome (FRNS) with steroid-toxic side effects are recommended...