Cyclosporine-a therapy in steroid dependent nephrotic syndrome: experience in amman, jordan

The use of Cyclosporin-A (CsA) has been well described and is currently recommended for use in patients with steroid dependent nephrotic syndrome (SDNS), especially when they start having steroid side effects. Over a three-year period, a total of 10 patients diagnosed as having SNDS at the King Hussein Medical Center, Amman, Jordan were retrospectively studied. Their mean age was 9.53 +/- 4.9 years. All patients included in the study failed to maintain long-term remission following cyclophosphamide therapy and had all manifested at least one steroid side effect prior to the introduction of CsA. Kidney biopsy was performed on all patients and all had normal renal functions prior to the introduction of CsA. After inducing remission with conventional steroid therapy, CsA was given in a dose of 4-6 mg/Kg/day orally in two divided doses and adjusted to maintain a mean blood trough level between 100 and 150 ng/ml. Total duration of therapy ranged between six and 24 months with a mean of 17 +/- 7.7. Steroid therapy was stopped in all patients within two months of starting CsA. Four patients relapsed after 4-6 months of stopping steroids. However, remission was re-induced when low dose alternate day prednisolone therapy was added. Two patients relapsed four months after stopping CsA, which was given for 24 months. Our study suggests that CsA is effective in maintaining long-term remission and decreasing steroid requirements in patients with SDNS.