Combined cyclosporine and prednisolone therapy using cyclosporine blood concentration monitoring for adult patients with new-onset minimal change nephrotic syndrome: a single-center pilot randomized trial

Shirai, Sayuri; Imai, Naohiko; Sueki, Shina; Matsui, Katsuomi; Tominaga, Naoto; Sakurada, Tsutomu; Yasuda, Takashi; Kimura, Kenjiro; Shibagaki, Yugo

doi:10.1007/s10157-017-1443-4

Cited by 6 publications

(4 citation statements)

References 19 publications

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“…Several RCTs examined the use of CNIs compared to glucocorticoids alone in adults with MCD and NS. 331,341,342 The quality of the evidence for these RCTs is low because there are concerns of serious risk of bias because of various study limitations and serious imprecision, as there are only a few studies, with a low number of participants (Supplementary Table S27 317,331,[341][342][343] ). These RCTs did not report critical clinical outcomes, all-cause mortality, or kidney failure.…”

Section: Key Informationmentioning

confidence: 99%

KDIGO 2021 Clinical Practice Guideline for the Management of Glomerular Diseases

Rovin¹,

Adler²,

Barratt³

et al. 2021

Kidney International

1,232

883

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S28 Introduction S30 Summary of recommendation statements and practice points S88 Chapter 1: General principles for the management of glomerular disease S115 Chapter 2: Immunoglobulin A nephropathy (IgAN)/immunoglobulin A vasculitis (IgAV) S128 Chapter 3: Membranous nephropathy S140 Chapter 4: Nephrotic syndrome in children S153 Chapter 5: Minimal change disease (MCD) in adults S161 Chapter 6: Focal segmental glomerulosclerosis (FSGS) in adults S172 Chapter 7: Infection-related glomerulonephritis S187 Chapter 8: Immunoglobulin-and complement-mediated glomerular diseases with a membranoproliferative glomerulonephritis (MPGN) pattern of injury S193 Chapter 9: Antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis S207 Chapter 10: Lupus nephritis S231 Chapter 11: Anti-glomerular basement membrane (Anti-GBM) antibody glomerulonephritis S235 Methods for guideline development S243 Biographic and disclosure information S254 Acknowledgments S256 ReferencesThis guideline is published as a supplement supported by KDIGO. The development and publication of this guideline are strictly funded by KDIGO, and neither KDIGO nor its guideline Work Group members sought or received monies or fees from corporate or commercial entities in connection with this work. The opinions or views expressed in this professional education supplement are those of the authors and do not necessarily reflect the opinions or recommendations of the International Society of Nephrology or Elsevier. Dosages, indications, and methods of use for products that are referred to in the supplement by the authors may reflect their clinical experience or may be derived from the professional literature or other clinical sources. Because of the differences between in vitro and in vivo systems and between laboratory animal models and clinical data in humans, in vitro and animal data may not necessarily correlate with clinical results.

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Section: Key Informationmentioning

confidence: 99%

KDIGO 2021 Clinical Practice Guideline for the Management of Glomerular Diseases

Rovin¹,

Adler²,

Barratt³

et al. 2021

Kidney International

1,232

883

View full text Add to dashboard Cite

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“…Meanwhile relapses in MCD are more frequent and often occur during GC reduction. Recent findings have also shown that when treated with steroids alone, the recurrence rate can be as high as 60% in 3 months [24]. Taken together, it could be speculated that a response to prior infection such as influenza caused the development of GBM nephritis and MCD simultaneously.…”

Section: Discussionmentioning

confidence: 98%

Nephrotic syndrome due to minimal-change disease superimposed on anti-glomerular basement membrane antibody positive glomerulonephritis; a case report

et al. 2020

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Background: The prognosis for renal function in anti-GBM glomerulonephritis (anti-GBM GN) is extremely poor, and when renal impairment progresses severely, it is difficult to expect improvement. In addition, it is also known that once the disease activity can be controlled by aggressive treatment, its recurrence is rare. We experienced an anti-GBM GN that improved from severe renal dysfunction and relapsed. A possible cause was the superimpose of nephrotic syndrome due to minimal change disease (MCD). Case presentation: A 30-year-old man was admitted to our hospital because of general malaise, fever, oliguria and renal dysfunction. The patient's laboratory data showed serum creatinine as high as 6.6 mg/dl, and severe inflammation (C-reactive protein 20.6 mg/dl). Anti-glomerular basement membrane antibody (anti-GBM Ab) was detected in his serum, which led to the diagnosis of anti-GBM GN. Treatment was initiated with high-dose glucocorticoid (GC) and plasma exchange therapy (PE), and the patient's renal function and oliguria improved rapidly and he was discharged 40 days after admission. Renal biopsy findings showed cellular crescents associated with linear IgG depositions along the glomerular tufts compatible with anti-GBM GN, but only about one-third of the glomeruli was involved, suggesting that it still remains an early stage of the disease. However, 2 months after discharge, he had a relapse and was readmitted due to severe proteinuria with positive anti-GBM Ab. On the second admission, after high-dose GC and PE combined with intravenous cyclophosphamide, and remission was achieved. Despite the relatively minor renal biopsy findings, the patient showed rapid renal dysfunction and relatively rapid improvement with our treatment. Electron microscopy of the renal biopsy tissue showed significant foot process effacement on podocytes in the apparently normal glomeruli, without electron dense deposits.

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“…There have been few studies on cyclosporine (CsA) monotherapy in adult MCD. Shirai et al [ 54 ] conducted a pilot open-label RCT in Japanese adults ( n = 21) with new-onset MCD. Adult new-onset MCD patients were initially treated with prednisolone (0.8 mg/kg) and 2 weeks after achieving proteinuria ≤1 g/day were randomized to CsA (2 mg/kg, goal CsA C2 level 600–1,200 ng/mL) with steroid taper by 4 months versus a prolonged prednisolone taper over 18 months.…”

Section: Steroid Minimization Approaches: Induction Of Remissionmentioning

confidence: 99%

Steroid Minimization in Adults with Minimal Change Disease

Koirala

Jefferson²

2021

Glomerular Dis

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Background: Minimal change disease (MCD) causes approximately 10% of nephrotic syndrome in adults. While glucocorticoids (GCs) effectively induce remission in MCD, the disease has a high relapse rate (50–75%), and repeated exposure to GCs is often required. The adverse effects of GCs are well recognized and commonly encountered with the high doses and recurrent courses used in MCD. Summary: In this review, we will discuss the standard therapy of MCD in adults and then describe new therapeutic options in induction therapy and treatment of relapses in MCD, minimizing the exposure to GCs. Key Messages: Steroid minimization strategies may decrease adverse effects in the treatment of MCD.

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Combined cyclosporine and prednisolone therapy using cyclosporine blood concentration monitoring for adult patients with new-onset minimal change nephrotic syndrome: a single-center pilot randomized trial

Cited by 6 publications

References 19 publications

KDIGO 2021 Clinical Practice Guideline for the Management of Glomerular Diseases

KDIGO 2021 Clinical Practice Guideline for the Management of Glomerular Diseases

Nephrotic syndrome due to minimal-change disease superimposed on anti-glomerular basement membrane antibody positive glomerulonephritis; a case report

Steroid Minimization in Adults with Minimal Change Disease

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