Yoshiyuki Kuroyanagi1, Yoshimitsu Gotoh2, Katsuaki Kasahara2, China Nagano2, Naoya Fujita3, Satoshi Yamakawa3, Masaki Yamamoto4, Asami Takeda5, Osamu Uemura6. 1. Division of Pediatric Nephrology, Department of Kidney Center, Aichi Medical University Hospital, 1-1 Yazako-Karimata, Nagakute, Aichi, 480-1195, Japan. kurochan2178@yahoo.co.jp. 2. Department of Pediatric Nephrology, Japan Red Cross Nagoya Daini Hospital, 2-9 Myouken-cho, Shouwa-ku, Nagoya, Aichi, 466-8650, Japan. 3. Department of Pediatric Nephrology, Aichi Children's Health and Medical Center, 1-2 Osakata, Morioka-cho, Oobu, Aichi, 474-8710, Japan. 4. Department of Pediatrics, Seirei Hamamatu General Hospital, 2-12-12 Sumiyoshi, Naka-ku, Hamamatu, Shizuoka, 430-0906, Japan. 5. Department of Nephrology, Japan Red Cross Nagoya Daini Hospital, 2-9 Myouken-cho, Shouwaku, Nagoya, Aichi, 466-8650, Japan. 6. Department of Nursing, Japanese Red Cross Toyota College of Nursing, 12-33 Nanamagari, Hakusan-cho, Toyota, Aichi, 471-8565, Japan.
Abstract
BACKGROUND: High dose of cyclosporine (CyA) for ≥2 years in children with steroid-dependent nephrotic syndrome (SDNS) increases the risk for nephropathy. Considering this, risk can be lowered with lower doses of CyA; we evaluated the effects of a medium dose of CyA, with target serum level, C2, of 450 ng/ml, over a 2-year period of observation, to determine the need for follow-up kidney biopsy. METHODS: We retrospectively evaluated C2 levels in 38 patients (17 males, 5.2 ± 2.9 years old) with SDNS at treatment initiation, at 6, 12 and 18 months during treatment, and at the time of kidney biopsy, 2-year after treatment initiation. Fifteen patients were also treated with mizoribine or mycophenolate mofetil. A number of relapses-per-patient-per-year, relative to SDNS onset and initiation of CyA treatment, were evaluated. Serum levels of total protein, albumin and total cholesterol, blood urea nitrogen level, and the estimated glomerular filtration rate were measured at treatment initiation and at 1- and 2-year post-treatment initiation. RESULTS: Only one very mild case of CyA-associated nephrotoxicity was identified based on biopsy results at 2-year post-treatment initiation. C2 concentrations were maintained at 422.2 ± 133.5 ng/ml and the number of relapses decreased from 3.0 relapses-per-patient-per-year prior to CyA treatment to 0.47 relapses-per-patient-per-year after CyA treatment. No effects of the treatment on the estimated glomerular filtration rate were noted. CONCLUSION: A 2-year treatment with a medium dose of cyclosporine A with or without other immunosuppressive agents is relatively safe with regard to the development of cyclosporine A nephrotoxicity.
BACKGROUND: High dose of cyclosporine (CyA) for ≥2 years in children with steroid-dependent nephrotic syndrome (SDNS) increases the risk for nephropathy. Considering this, risk can be lowered with lower doses of CyA; we evaluated the effects of a medium dose of CyA, with target serum level, C2, of 450 ng/ml, over a 2-year period of observation, to determine the need for follow-up kidney biopsy. METHODS: We retrospectively evaluated C2 levels in 38 patients (17 males, 5.2 ± 2.9 years old) with SDNS at treatment initiation, at 6, 12 and 18 months during treatment, and at the time of kidney biopsy, 2-year after treatment initiation. Fifteen patients were also treated with mizoribine or mycophenolate mofetil. A number of relapses-per-patient-per-year, relative to SDNS onset and initiation of CyA treatment, were evaluated. Serum levels of total protein, albumin and total cholesterol, blood ureanitrogen level, and the estimated glomerular filtration rate were measured at treatment initiation and at 1- and 2-year post-treatment initiation. RESULTS: Only one very mild case of CyA-associated nephrotoxicity was identified based on biopsy results at 2-year post-treatment initiation. C2 concentrations were maintained at 422.2 ± 133.5 ng/ml and the number of relapses decreased from 3.0 relapses-per-patient-per-year prior to CyA treatment to 0.47 relapses-per-patient-per-year after CyA treatment. No effects of the treatment on the estimated glomerular filtration rate were noted. CONCLUSION: A 2-year treatment with a medium dose of cyclosporine A with or without other immunosuppressive agents is relatively safe with regard to the development of cyclosporine Anephrotoxicity.
Authors: Christian A Devaux; Cléa Melenotte; Marie-Dominique Piercecchi-Marti; Clémence Delteil; Didier Raoult Journal: Front Med (Lausanne) Date: 2021-09-06
Authors: Tessa A M Mulder; Ruben A G van Eerden; Mirjam de With; Laure Elens; Dennis A Hesselink; Maja Matic; Sander Bins; Ron H J Mathijssen; Ron H N van Schaik Journal: Front Genet Date: 2021-07-08 Impact factor: 4.599