Clinical evaluation of chronic nephrotoxicity of long‐term cyclosporine A treatment in adult patients with steroid‐dependent nephrotic syndrome

Okada, Tomonari; Matsumoto, Hiroshi; Nagaoka, Yume; Tomaru, Ryo; Iwasawa, Hideaki; Wada, Toshikazu; Nakao, Toshiyuki

doi:10.1111/j.1440-1797.2010.01425.x

Cited by 7 publications

(6 citation statements)

References 31 publications

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“…In the present study, the levels of proteinuria decreased dramatically in the patients treated with the combined therapy, while the eGFR values increased, indicating that the role of CsA in reducing proteinuria is not limited to its effects in improving glomerular hemodynamics and reducing glomerular filtration. The biggest problem associated with CsA treatment is renal toxicity, which can result in damage to the renal function by inducing renal vasoconstriction and interstitial fibrosis (34)(35)(36). Our study showed that even though we used a medium dose of 3 mg/kg/d as the initial dose of CsA, more than 25% of the patients treated with the combined therapy showed a transient drop in eGFR, although most of them quickly returned to their previous values.…”

Section: Discussionmentioning

confidence: 69%

“…On the other hand, CsA has an antiproteinuric effect independent of its immunosuppressive function in T cells,directly resulting from the stabilization of the podocyte actin cytoskeleton (32). Research has showed that the administration of CsA can reduce proteinuria in patients with many types of chronic glomerulonephritis and nephrotic syndrome, even those who are resistant to steroids (33,34). In our prospective, randomized, controlled trial, we showed that treatment with both full-dose corticosteroids alone and mediumdose glucocorticoids combined with CsA rapidly reduces proteinuria, even by the end of the first month of treatment.…”

Section: Discussionmentioning

confidence: 99%

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Comparison of Glucocorticoids Alone and Combined with Cyclosporine A in Patients with IgA Nephropathy: A Prospective Randomized Controlled Trial

Liu

Fang

et al. 2014

Intern. Med.

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Objective The aim of this study was to investigate the effects of two different treatment regimes in patients with IgA nephropathy (IgAN): steroids alone and in combination with a medium dose of cyclosporine A (CsA). Methods Forty-eight IgAN patients 18-69 years of age with proteinuria >1.0 g/24 hours and an estimated glomerular filtration rate (eGFR) of >30 mL/min/1.73 m 2 were randomly given either steroids alone (methylprednisolone (MP) group; n=25) or steroids plus CsA treatment (combination group; n=23). The primary endpoint was the reduction of proteinuria by 50% or more of the baseline value. The secondary endpoint was an increase in the baseline serum creatinine level of 50% or a decrease in the baseline eGFR of 25%. Results After 12 months of treatment, all patients in the combination group and 87.50% of the patients in the MP group reached the primary endpoint. The complete remission rates in the combination group and MP group were 50.0% and 45.83%, respectively. The level of urinary protein excretion declined from 3.17 ± 3.25 g/24 hours to 0.36 ± 0.23 g/24 hours (p<0.001) in the combination group and from 2.60 ± 2.03 g/24 hours to 0.53 ± 0.71 g/24 hours (p<0.001) in the MP group. Two patients in the combination group reached the secondary endpoint, with a decrease in the eGFR of 25% from the baseline value, while no patients in the MP group achieved this goal. The patients in the combination group exhibited significant improvements in the eGFR after nine months (90.16 ± 28.78 vs. 80.46 ± 22.73 mL/min.1.73 m 2 , p=0.011), while the patients in the MP group showed significant increases in the eGFR after six months of treatment (92.18 ± 22.71 to 81.63 ± 18.36 mL/min/1.73 m 2 , p=0.019). Four patients (8.33%) developed severe pneumonia during treatment. Conclusion Both the full dose of steroids alone and combined treatment with steroids and a medium dose of CsA remarkably reduced the levels of proteinuria and ameliorated the renal function in the IgAN patients. Infection was the most serious complication during the treatment.

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Section: Discussionmentioning

confidence: 69%

Section: Discussionmentioning

confidence: 99%

Comparison of Glucocorticoids Alone and Combined with Cyclosporine A in Patients with IgA Nephropathy: A Prospective Randomized Controlled Trial

Liu

Fang

et al. 2014

Intern. Med.

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“…Антипротеинурическое действие ингибиторов кальциневрина состоит в стабилизации актиново-го скелета подоцитов через их иммуномодулиру-ющий эффект на Т-клетки. Эта стратегия требует очень тщательного мониторинга их уровней [71,72]. В двух небольших проспективных исследова-ниях было описано использование такролимуса с преднизолоном [73,74].…”

Section: лечение стероидзависимых пациентов с фсгсunclassified

Фокально-Сегментарний Гломерулосклероз: Генетичний Аналіз І Цільова Терапія

Melnyk¹

2021

KIDNEYS

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“…41 This strategy requires close monitoring of trough levels and kidney function. 42 The use of tacrolimus with prednisone has been described in two small prospective studies. 43,44 A Chinese trial compared the association of tacrolimus with prednisone to the association of IV cyclophosphamide with prednisone given to 33 adults with steroid-dependent or steroid-resistant FSGS: they reported 6-and 12-month cumulative remission rates of 67% and 73%, respectively, in the tacrolimus-prednisone group compared with 56% and 67%, respectively, in the cyclophosphamide-prednisone group.…”

Section: Treatment Of Steroid-dependent Nephrotic Syndrome In Patientmentioning

confidence: 99%

Optimal management of primary focal segmental glomerulosclerosis in adults

Beaudreuil¹,

Lorenzo²,

Elias³

et al. 2017

IJNRD

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Focal segmental glomerulosclerosis (FSGS) is a frequent glomerular kidney disease that is revealed by proteinuria or even nephrotic syndrome. A diagnosis can be established from a kidney biopsy that shows focal and segmental glomerulosclerosis. This histopathological lesion may be caused by a primary podocyte injury (idiopathic FSGS) but is also associated with other pathologies (secondary FSGS). The first-line treatment for idiopathic FSGS with nephrotic syndrome is a prolonged course of corticosteroids. However, steroid resistance or steroid dependence is frequent, and despite intensified immunosuppressive treatment, FSGS can lead to end-stage renal failure. In addition, in some cases, FSGS can recur on a graft after kidney transplantation: an unidentified circulating factor may be implicated. Understanding of its physiopathology is unclear, and it remains an important challenge for the scientific community to identify a specific diagnostic biomarker and to develop specific therapeutics. This study reviews the treatment of primary FSGS and the recurrence of FSGS after kidney transplantation in adults.

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Clinical evaluation of chronic nephrotoxicity of long‐term cyclosporine A treatment in adult patients with steroid‐dependent nephrotic syndrome

Abstract: Mild decrease in renal function and hypomagnesemia were found in adult SDNS patients with long-term CsA treatment. Careful monitoring of renal function, blood pressure and serum magnesium levels is necessary.

Cited by 7 publications

References 31 publications

Comparison of Glucocorticoids Alone and Combined with Cyclosporine A in Patients with IgA Nephropathy: A Prospective Randomized Controlled Trial

Comparison of Glucocorticoids Alone and Combined with Cyclosporine A in Patients with IgA Nephropathy: A Prospective Randomized Controlled Trial

Фокально-Сегментарний Гломерулосклероз: Генетичний Аналіз І Цільова Терапія

Optimal management of primary focal segmental glomerulosclerosis in adults

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