CYCLOSPORINE-A IN POORLY STEROID RESPONSIVE NEPHROTIC SYNDROME

Cyclosporin A can be effective in some cases of idiopathic nephrotic syndrome with bad response to steroids. We evaluated the effect of Cyclosporin A in 6 adult patients with nephrotic syndrome. Five of them had received prednisone alone or with immunossuppresive agents without any favorable response. Kidney biopsy showed focal glomerulosclerosis in three cases, diffuse mesangial proliferation with lgM deposits in two and minimal change nephropathy in the last one. Treatment with Cyclosporin was mantained during 9-12 months. It was started at 4-5 mg/kg/day and was decreased progressively to a mean dosage of 2.5 mg/kg/day at six months of treatment. In three patients, 20 mg of prednisone every other day were added to Cyclosporin treatment. Proteinuria decreased or disappeared in all the cases at three months of treatment (9.3 +/- 5,5 g/d vs 0.2 +/- 0.35 g/d) with a parallel improvement of nephrotic syndrome. Renal function measured as creatinine clearance was not modified in any case. Three patients relapsed, two of them during treatment and the third, twelve weeks after discontinuation of therapy. Three patients are in partial remission with proteinuria less than 1 g/day at 9-12 months after discontinuation of the treatment. Side effects were minimal and reversible. We conclude that low doses of Cyclosporin A could be effective in the management of adult idiopathic nephrotic syndrome with bad response to steroids. However, a high percentage relapse after therapy is stopped. This suggests that long-term Cyclosporin A therapy could be effective in the management of adult idiophathic nephrotic syndrome with bad response to steroids, but that minimum doses must be found.