Nephrotoxicity of once-daily cyclosporine A in minimal change nephrotic syndrome

• Published in: Pediatric nephrology (Berlin, West) West), 2012-04, Vol.27 (4), p.671-674
• Main Authors: Fujinaga, Shuichiro, Hirano, Daishi, Murakami, Hitohiko, Ohtomo, Yoshiyuki, Shimizu, Toshiaki, Kaneko, Kazunari
• Format: Article
• Language: English
• Subjects: Adolescent; Analysis; Biopsy; Brief Report; Care and treatment; Child; Child, Preschool; Corticosteroids; Cyclosporine; Cyclosporine - administration & dosage; Cyclosporine - adverse effects; Female; Humans; Immunosuppressive Agents - administration & dosage; Immunosuppressive Agents - adverse effects; Infant; Kidney - drug effects; Kidney - pathology; Kidney diseases; Male; Medicine; Medicine & Public Health; Nephrology; Nephrosis, Lipoid - drug therapy; Nephrosis, Lipoid - pathology; Nephrotic syndrome; Pediatrics; Prednisolone; Steroids; Urology
• ISSN: 0931-041X; 1432-198X
• DOI: 10.1007/s00467-011-2076-6

Background Although once-daily cyclosporine (CsA) therapy may have greater nephrotoxic-sparing effects than standard twice-daily therapy, little information is available in children with steroid-dependent minimal change nephrotic syndrome (MCNS) regarding histological analysis after long-term once-daily administration. Case-Diagnosis/Treatment A prospective study of the clinical efficacy and comparison between pre- and post-treatment renal biopsy findings in ten children (mean age, 8.8 years) with steroid-dependent MCNS who were administered once-daily CsA therapy for more than 24 months (mean ± SD, 30 ± 3.7) was performed in Saitama Children’s Medical Center. Administration of once-daily CsA therapy (mean dose, 2.8 ± 0.6 mg/kg/day; mean C2 levels, 670 ± 64 ng/ml) resulted in a significant reduction in the median relapse rate from 4.6 to 0.2 times per year, and five patients did not experience a relapse of NS. Furthermore, mean threshold of prednisolone dose significantly reduced from 1.2 to 0.02 mg/kg on alternate days. However, two patients showed evidence of chronic CsA nephrotoxicity (CsAN). Conclusions Once-daily CsA therapy appears to be effective in children with steroid-dependent MCNS. However, follow-up renal biopsies should be performed to investigate the presence of CsAN after more than 24 months of treatment with once-daily regimen as well as with the conventional twice-daily regimen.