[The treatment of children with idiopathic nephrotic syndrome using cyclosporin]

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R A Donckerwolcke1, J G Vande Walle

  • 1Universiteitskliniek Wilhelmina Kinderziekenhuis, Utrecht.

Nederlands Tijdschrift Voor Geneeskunde
|September 5, 1992
PubMed

Insights

Cyclosporine effectively induced remission in children with nephrotic syndrome, but relapses occurred after discontinuation. Severe nephrotoxicity limited its use, suggesting restriction to steroid-dependent cases with significant steroid toxicity.

Area of Science:

  • Pediatric Nephrology
  • Immunosuppressive Therapy

Context:

  • Steroid-dependent and steroid-resistant nephrotic syndrome (NS) pose significant challenges in pediatric care.
  • Current treatment strategies often involve corticosteroids, which can lead to toxicity and dependence.

Purpose:

  • To evaluate the efficacy and safety of cyclosporine in children with steroid-dependent and steroid-resistant nephrotic syndrome.
  • To assess remission rates, recurrence patterns, and long-term histopathological changes associated with cyclosporine treatment.

Summary:

  • Cyclosporine, at 6 mg/kg/day targeting blood levels of 60-100 ng/ml, induced remission in 15 of 21 pediatric NS patients.
  • Remission was sustained off prednisone in 9 patients, but 5 relapsed upon cyclosporine withdrawal.
  • Nephrotoxicity was observed in 9 of 13 patients undergoing repeat biopsy, necessitating cyclosporine withdrawal in 4.

Impact:

  • Cyclosporine demonstrates potential for inducing remission in difficult-to-treat pediatric nephrotic syndrome.
  • Careful patient selection is crucial due to the risk of significant nephrotoxicity.
  • Findings support restricting cyclosporine to steroid-dependent NS patients experiencing severe steroid-related toxicity.

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