Cyclosporine in the treatment of idiopathic nephrosis.

Niaudet, Patrick; Habib, R

doi:10.1681/asn.v541049

Cited by 110 publications

(8 citation statements)

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“…Prema etiopatogenezi, postoje primarni i sekundarni nefrotski sindrom. Proseèna godišwa incidencija primarnog, ili idiopatskog, nefrotskog sindroma (INS) kod dece je od dva nova sluèaja do sedam novih sluèajeva obolevawa, a prevalencija oko 16 obolelih na 100.0-00 dece mlaðe od 18 godina [2][3][4].…”

Section: Uvodunclassified

“…Bazu imunomodulacione terapije u INS èine kortikosteroidi (u daqem tekstu steroidi). Klinièko iskustvo je pokazalo da odgovor na steroidnu terapiju ima veaei prognostièki znaèaj od histološkog nalaza biopsije bubrega uraðene na poèetku bolesti [1][2][3][4]. Prema tome, zavisno od odgovora na steroide, razlikujemo dva podtipa INS: "steroid-senzitivni" INS se javqa kod bolesnika koji na steroidnu terapiju reaguju normalizacijom proteinurije i gubitkom znakova bolesti, a "steroid-rezistentni" INS kod bolesnika koji ne reaguju na pomenutu terapiju.…”

Section: Uvodunclassified

“…Prema podacima Internacionalne studije bolesti bubrega kod dece (ISKDC), 84,5% bolesnika sa primarnim nefrotskim sindromom ima nefrotski sindrom sa vrlo malim histološkim promenama (MCNS), 9,5% bolesnika boluje od FSGS a 2,5% od mezangioproliferativnog glomerulonefritisa (MzPGN) [2]. Ove tri grupe bolesti se jednim imenom nazivaju "idiopatski nefrotski sindrom", jer još nije usaglašeno mišqewe da li ti oblici nefrotskog sindroma predstavqaju razlièite bolesti ili su samo varijante i moguaei teži evolucioni tok jednog oboqewa [1,3]. Primer naše bolesnice govori u prilog pretpostavci da su MzPGN i FSGS evolucioni oblici iste bolesti koja se klinièki ispoqava teškim nefrotskim sindromom i da slabo reaguju na leèewe steroidima i drugim imunosu-presivnim lekovima.…”

Section: Diskusijaunclassified

“…Posle bezuspešnog leèewa steroidima vredi pokušati sa CyA, odnosno ciklofosfamidom. Mada su mnoga ispitivawa pokazala da je CyA efikasniji kod steroid-senzitivnih nego kod steroid-rezistentnih bolesnika, on se kod ovih posledwih preporuèuje u kombinaciji sa alternativnim i/ili malim dozama prednizona [3]. CyA se mora primeniti sa velikom pažwom kod bolesnika sa FSGS koji su pre terapije imali tubulointersticijske lezije [3].…”

Section: Diskusijaunclassified

“…Mada su mnoga ispitivawa pokazala da je CyA efikasniji kod steroid-senzitivnih nego kod steroid-rezistentnih bolesnika, on se kod ovih posledwih preporuèuje u kombinaciji sa alternativnim i/ili malim dozama prednizona [3]. CyA se mora primeniti sa velikom pažwom kod bolesnika sa FSGS koji su pre terapije imali tubulointersticijske lezije [3]. Ukoliko nema terapijskog odgovora u toku èetiri meseca, prekida se primena CyA da bi se izbegla nefrotoksiènost.…”

Section: Diskusijaunclassified

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The benefit of plasma exchange in anuric patient with steroid-resistant nephrotic syndrome - long-term follow-up

et al. 2004

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Recently, plasma exchange (PE) has been added to the treatment regimen for patients with steroid-, cyclophosphamide-, and cyclosporine-resistant nephrotic syndrome. This is a case report of a female patient with severe acute renal failure (ARF) during the relapse of steroid-resistant nephrotic syndrome (SRNS) who recovered completely after PE and became steroid-sensitive in further follow-up of 48 months. An 8-year-old girl was referred to Nephrology Department of the University Children's Hospital due to relapse of SRNS complicated with ARF. Her nephrotic syndrome (mesangioproliferative glomerulonephritis) was diagnosed at the age of 17 months. During the following 6 years, she was given several therapeutic regimens including pulse prednisolone, cyclophosphamide, Cyclosporine (CyA), but she continued to have frequent relapses and during the last six months she was steroid- and cyclosporine-resistant. Three days before admission, she was febrile, had cellulites of the lower abdominal wall, diarrhea, vomiting, hypovolemic shock with generalized edema, severe hypoproteinemia and hypoalbuminemia. In a local hospital, she was treated with fresh frozen plasma, albumin, methylprednisolone, furosemide and antibiotics, but she became anuric and was referred to our hospital. There were no signs of hemolysis. Anuria lasted for 12 days. She was discharged after 42 days in remission with normal GFR. Principal treatment included: 13 sequential hemodialysis sessions (30% of body weight was removed as excess volume), 6 PE, corticosteroids, CyA, ACE inhibitor, antibiotics, antimycotics, and cimetidine. Six PE sessions were performed every other day. In further 48-month follow-up, while under the treatment of CyA the patient had a few steroid-sensitive relapses, the first being 6 months after PE. The second kidney biopsy showed focal segmental glomerulosclerosis with no signs of apparent CyA nephrotoxicity. "Malignant" course of disease in our patient was a good reason to introduce PE into the treatment. Since PE was the only additional mode of treatment, it is believed that its effect was crucial for milder activity of the disease.

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The benefit of plasma exchange in anuric patient with steroid-resistant nephrotic syndrome - long-term follow-up

et al. 2004

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Interventions for minimal change disease in adults with nephrotic syndrome

Palmer

Nand

Strippoli

2008

Cochrane Database of Systematic Reviews

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Lymphocyte Responsiveness to Glucocorticoids, Cyclosporine, or Both

Briggs

Gao

Gimenez

et al. 1996

The Journal of Clinical Pharma

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The reason why some patients with glomerular diseases respond to steroid treatment and others do not remains obscure, and it is not possible to prospectively evaluate the probability of response in individual patients. One factor that might contribute to the clinical response to treatment could be the relative sensitivity of a patient's immune system to the suppressive effects of steroids or other immunosuppressive agents. To evaluate this possibility, phytohemagglutinin (PHA)-stimulated peripheral blood mononuclear cells (PBMC) from 16 patients with various biopsy-proven glomerulopathies were cultured with prednisolone or methylprednisolone in final concentrations of 10(-5) to 10(-8) mol/L. From the dose-response curves, the concentration of steroid required to cause 50% inhibition (IC50) of the PHA-induced proliferative response was determined. The PBMC from 10 patients also were cultured with 400 ng/mL cyclosporine both alone and with 10(-7) mol/L steroid, and the inhibitory effects were calculated. There was considerable heterogeneity in the sensitivities of individual patients to steroid inhibition, and the mean +/- SEM IC50 was significantly lower for methylprednisolone than for prednisolone. Cyclosporine caused 50% or greater inhibition in 6 of the 10 patients but had < 10% inhibitory effect in 2 patients. In most patients studied, cyclosporine plus steroid was significantly more inhibitory than cyclosporine alone, but the combination was usually no more effective than 10(-7) mol/L methylprednisolone alone. These results are consistent with the hypothesis that differences in the sensitivity of individual patient's immune systems to the immunosuppressive effects of steroids and cyclosporine might contribute to differences in their clinical responsiveness to treatment.

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Cyclosporine in the treatment of idiopathic nephrosis.

Cited by 110 publications

References 0 publications

The benefit of plasma exchange in anuric patient with steroid-resistant nephrotic syndrome - long-term follow-up

The benefit of plasma exchange in anuric patient with steroid-resistant nephrotic syndrome - long-term follow-up

Interventions for minimal change disease in adults with nephrotic syndrome

Lymphocyte Responsiveness to Glucocorticoids, Cyclosporine, or Both

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