Objective There have been few studies on cyclosporine (CsA) monotherapy in adult minimal change nephrotic syndrome (MCNS). To delineate CsA therapy as new treatment options for MCNS, we conducted a prospective single-center study.Methods We assessed the efficacy of 3 different regimens in 36 patients, consisting of 26 first attacks or 10 relapses, of adult-onset MCNS. In 12 patients, CsA alone was given orally at a dose of 2-3 mg/kg/d, and in 12 patients, CsA after intravenous pulse methylprednisolone therapy (CsA/PMT) was given at the same dose. CsA was given for 12 months, tapered slowly, then stopped. The other 12 patients were treated with oral prednisolone (PSL, 40-60 mg/d) alone for 4 to 6 weeks, followed by daily PSL, with slowly tapering doses.Results Complete remission (CR) was obtained in 75% with CsA alone, 100% with CsA/PMT and 92% with PSL alone (p=0.0379). The days required for CR were shortest in the CsA/PMT group (40.9±35.5 days with CsA alone vs. 11.0±5.6 with CsA/PMT vs. 21.5±15.8 with PSL alone). The cumulative rates of CR were significantly different among the 3 groups (p<0.0001). The real numbers of the relapse were smallest in the CsA/PMT group, however, the cumulative rates of sustained remission among the 3 treatment arms were not statistically different. Renal function was well preserved with each treatment period. CsA-associated adverse effects were minimal but one patient developed new-onset hypertension and gingival hyperplasia. However, the adverse effects of PSL alone were serious in 3 cases: bleeding from gastric ulcer, diabetes mellitus, and aseptic necrosis.

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Icodextrin peritoneal dialysis solution reportedly benefits patients suffering from metabolic derangement due to glucose load from dialysate. However, the effects of icodextrin on insulin resistance and adipocytokine profile remain unclear. Subjects comprised 14 stable patients on peritoneal dialysis for >6 months. Their mean age was 57 +/- 11 years and the mean duration of peritoneal dialysis was 49 +/- 30 months. Patients were classified into groups according to the index of insulin resistance (index of homeostasis model assessment: HOMA-IR): Group A, HOMA-IR < 2.0 (n = 7); and Group B, HOMA-IR >or= 2.0 (n = 7). Glucose peritoneal dialysis solution was subsequently switched to icodextrin once daily during the night. Changes in HOMA-IR and adipocytokine profiles were examined after three months. The glucose absorption dose tended to decrease in both groups after icodextrin introduction, with significant reductions in Group B. No changes were seen in body mass index, fluid status, peritoneal dialysis dose, residual renal function or fasting plasma glucose levels in either group. Plasma insulin levels were unchanged in Group A, but decreased significantly in Group B. The index of insulin resistance was thus unchanged in Group A (from 1.4 +/- 0.4 to 1.5 +/- 0.8) and significantly decreased in Group B (from 5.9 +/- 2.2 to 3.2 +/- 0.6; P < 0.01). Regarding plasma adipocytokine profiles, no changes were found in plasma leptin, tissue necrosis factor-alpha or total plasminogen activator inhibitor-1 levels in either group. Plasma adiponectin levels were unchanged in Group A, but significantly increased in Group B. Icodextrin solution could ameliorate insulin resistance by decreasing insulin levels due to a reduction in the glucose load and an increase in plasma adiponectin levels.

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