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Correlation between finger-prick and venous ciclosporin levels: association with gingival overgrowth and hypertrichosis

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Abstract

The aims of this study were (1) to ascertain ciclosporin C2 levels currently being achieved in children with steroid-sensitive nephrotic syndrome (SSNS) and renal transplants (RTs), (2) to determine the feasibility of the use of finger-prick samples for the measurement of ciclosporin levels, and (3) to identify any correlation between hypertrichosis or gingival overgrowth (GO) and level of ciclosporin 2 h post-dose (C2). Seventy-two children (39 with SSNS, 33 with RT) participated. Ciclosporin 12 h trough (C12) and C2 levels were measured in venous and finger-prick samples by high-performance liquid chromatography tandem mass spectroscopy. Photographs of the teeth and back were taken for assessment of GO and hypertrichosis. Mean (±SD) C2 levels in the SSNS and RT groups were 512 (±181) μg/l and 471 (±229) μg/l. There was a highly significant relationship between venous and finger-prick ciclosporin levels (r2 = 0.96, P < 0.0001). Fourteen children had severe GO. There was a small, though statistically significant, impact of ciclosporin level on GO (C2 r2 = 0.12, P = 0.003 and C12 r2 = 0.06, P = 0.038) but no correlation with dose (milligrammes per kilogramme per day or milligrammes per square metre per day) or duration. Seventeen children had moderate or severe hypertrichosis, this being more common in children of South Asian ethnicity (P < 0.0001). There was no correlation between ciclosporin exposure or duration and hypertrichosis. Finger-prick blood sampling may serve as a practical alternative to venepuncture in children receiving ciclosporin.

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Acknowledgements

This study was funded by an unrestricted educational grant from Novartis Pharmaceuticals UK. The authors would like to thank the nursing staff in the outpatient departments for collecting the blood samples and all of the following paediatric nephrologists who contributed patients to the study: Dr. Jim Beattie, Dr. Mark Bradbury, Dr. Sally Hulton, Dr. Heather Lambert, Dr. Malcolm Lewis, Dr. David Milford, Dr. Nadeem Moghal, Dr. Milos Orjanovic, Dr. Nick Plant, Dr. Ian Ramage, Dr. Judy Taylor, Dr. Mark Taylor and Dr. Judith van der Voort.

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Authors and Affiliations

  1. British Association for Paediatric Nephrology, Manchester, UK

    Nicholas J. A. Webb, Malcolm G. Coulthard, Richard S. Trompeter, Margaret M. Fitzpatrick, Suzanne Stephens, Jan Dudley, Heather Maxwell, Simon Waller, Graham C. Smith, Alan R. Watson & David A. Hughes

  2. Department of Biochemistry, Wythenshawe Hospital, Manchester, UK

    Brian G. Keevil

  3. School of Dental Sciences, University of Newcastle upon Tyne, Newcastle upon Tyne, UK

    Janice S. Ellis

  4. Department of Paediatric Nephrology, Royal Manchester Children’s Hospital, Manchester, M27 4HA, UK

    Nicholas J. A. Webb

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  1. Nicholas J. A. Webb
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  2. Malcolm G. Coulthard
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  3. Richard S. Trompeter
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  4. Margaret M. Fitzpatrick
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  13. Janice S. Ellis
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Correspondence to Nicholas J. A. Webb.

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Webb, N.J.A., Coulthard, M.G., Trompeter, R.S. et al. Correlation between finger-prick and venous ciclosporin levels: association with gingival overgrowth and hypertrichosis. Pediatr Nephrol 22, 2111–2118 (2007). https://doi.org/10.1007/s00467-007-0586-z

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  • DOI: https://doi.org/10.1007/s00467-007-0586-z

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