Cyclosporine A treatment of focal and segmentary glomerulosclerosis in children
Abstract
Twenty one children aged 1,5-16 years with steroid-resistant GN and biopsy-proven focal and segmentary glomerulosclerosis (FSGS) were treated with Cyclosporine A (CsA) 4-5 mg/kg as initial dosage and oral prednisolone 1-1,5 mg/kg every other day tapered to the 12-th month. Methylprednisolone pulses (MP) 30 mg/kg every other day for the first 2-4 weeks were used in 14 patients. The duration of the disease before treatment varied from 6 months to 7 years. After 6 months of treatment complete absence of proteinuria was achieved in 8 (38%) children, partial remission was found in 5 (24%) patients, more than 2-fold decrease in proteinuria was observed in 2 (10%) children. In 6 (28%) children including one patient who developed the ESRD the treatment had no effect. After one year of treatment complete remission was observed in 11 (55%) patients, partial remission was observed in 4 (20%) children, a decrease in proteinuria was found in 1 (5%) patient and no effect was achieved in 5 (25%) children. In all non-responders, the CsA-treatment was terminated. The MP-pulses were not used in 7 patients because of less severe disease or contraindications. However, 6 of them demonstrated a good response to treatment. None of responders had any severe side effects of CsA. In 8 patients the CsA-treatment was continued for 18 months. Only in 1 case an additional biopsy showed the tubular interstitial toxicity because the dose of CsA was tapered from 4 to 2 mg/kg. Five children were treated with CsA for 2 years, 4 of them had no any side effects. In one case an increase in serum creatinine level demanded tapering the CsA-dose. We conclude that early and prolonged treatment with CsA can provide complete or partial remission of GN in about 75% of patients with idiopathic FSGS.
About the Authors
O. V. Komarova
Научный центр здоровья детей РАМН
Russian Federation
Russian Federation
A. N. Tsygin
Научный центр здоровья детей РАМН
Russian Federation
Russian Federation
A. V. Sukhanov
Научный центр здоровья детей РАМН
Russian Federation
Russian Federation
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Review
For citations:
Komarova O.V., Tsygin A.N., Sukhanov A.V. Cyclosporine A treatment of focal and segmentary glomerulosclerosis in children. Nephrology and Dialysis. 2006;8(3):249-253. (In Russ.)
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