Skip to main content
SpringerLink
Log in

The use of cyclosporin a in adult nephrotic syndrome: Nine cases and literature review

  • Published:
Irish Journal of Medical Science Aims and scope Submit manuscript

Summary

Nine adult patients with resistant nephrotic syndrome were treated with cyclosporin A (CyA). All had failed to respond to high dose corticosteroids with or without cyclophosphamide. Three patients had minimal change disease, 3 had focal sclerosing glomerulosclerosis (FSGS), 2 had mesangio-capillary GN, and one had membranous nephropathy. The mean age of the patients was 26.4 years (range 16 to 39 years). CyA was given orally twice daily at a mean dose of 6.7 mg/kg/24 hours (range 6–10 mg/kg/24 hours).

Four patients achieved full remission, two patients went into partial remission, and three failed to respond. Two patients developed clinical nephrotoxicity, which reversed on dose reduction or cessation of CyA. All 3 patients with minimal change disease who responded subsequently relapsed after stopping CyA, but remitted rapidly on reintroduction of the drug.

We suggest that the mode of action of CyA in nephrotic syndrome may be related to intra-renal vasoconstriction in addition to its direct immunosuppressive effect. In this limited series, we found that CyA can be an effective therapy for otherwise refractory nephrotic syndrome, although relapse on withdrawal of CyA may well be a significant clinical problem.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Glassock, R. J., Cohen, A. H., Bennett, C. M. and Martinez-Maldonado, M. Primary glomerular diseases. In: Brenner, B. M. and Rector, F. C. Jr., eds. The Kidney, 2nd ed. W. B. Saunders, Philadelphia. 1981: p. 349–351.

    Google Scholar 

  2. Maffick, N. P. Pathogenesis of minimal change nephropathy. Clin. Nephrol. 1977: 9, 87–95.

    Google Scholar 

  3. Shalboub, R. J. Pathogenesis of lipoid nephrosis: a disorder of T-cell function. Lancet 1974: ii, 556–560.

    Article  Google Scholar 

  4. Borel, J. F. and Lafferty, K. J. Cyclosporin: speculation about its mechanism of action. Transplant Proc. 1983: 15, 1881–1885.

    CAS  Google Scholar 

  5. Hoyer, P.,Krull, F., Brodehl, J. Cyclosporin in frequently relapsing minimal change syndrome. Lancet 9 Aug. 1986: 335.

  6. Meyrier, A., Simon, P., Perret, G. et al. Remission of idiopathic nephrotic syndrome after treatment with cyclosporin A. B.M.J. (Clin. Res.) 1986: 292, 789–792.

    CAS  Google Scholar 

  7. Tejani, A., Butt, K., Trachtman, T. et al. Cyclosporin induced remission of relapsing nephrotic syndrome in children. Kidney Int. 1988: 33, 729–734.

    Article  PubMed  CAS  Google Scholar 

  8. Cohen, D. J., Loertscher, R., Rubin, M. F. et al. Cyclosporin: a new immunosuppressive agent for organ transplantation. Ann. Int. Med. 1984: 101, 667–682.

    PubMed  CAS  Google Scholar 

  9. Baran, D., Vendeville, B., Vial, M. C. et al. Effect of cyclosporin A on mercury-induced autoimmune glomerulonephritis in the Brown Norway rat. Clin. Nephrol. 1986: 25, Suppl. No. 1. S175-S180.

    PubMed  CAS  Google Scholar 

  10. Gunn, H. C. and Ryffel, B. Glomerulonephritis in NZ B/W mice: therapeutic effect of cyclosporin. Clin. Nephrol. 1986: 25, Suppl. No. 1. S189-S192.

    PubMed  CAS  Google Scholar 

  11. Neild, G. H., Ivory, K. and Williams, D. G. Effect of cyclosporin on proteinuria in chronic serum sickness in rats. Clin. Nephrol. 1986: Suppl. No. 1. S186–S188.

  12. Thaiss, E., Mihatsch, M. J., Batsford, S. et al. Effect of cyclosporin on in situ immune complex glomerulonephritis. Clin Nephrol. 1986: Suppl. No. 1.S181–S185.

  13. Tipping, P. G. and Holds worth, S.R. Effect of cyclosporin A on antibody induced experimental glomerulonephritis. Nephron. 1985: 40, 201–205.

    Article  PubMed  CAS  Google Scholar 

  14. Humes, H. D. et al. Pathogenic mechanisms of nephrotoxicity: insights into cyclosporin nephrotoxicity. Transplant Proc. Vol XVII No. 4. Suppl. 1 (Aug.) 1985: 51–62.

    Google Scholar 

  15. Murray, B. M., Paller, M. S. and Ferris, T. F. Effect of cyclosporin administration on renal haemodynamics in conscious rats. Kidney Int. 1985: 28, 767–774.

    Article  PubMed  CAS  Google Scholar 

  16. Bantle, J. P., Boudreau, R. J., Ferris, T. F. Suppression of plasma renin activity by cyclosporin. Am. J. Med. 1987: 83, 59–64.

    Article  PubMed  CAS  Google Scholar 

  17. Lagrue, G., Laurent, J., Belghitti, D. et al. Cyclosporin and idiopathic nephrotic syndrome. Lancet 1986: ii, 692–693.

    Article  Google Scholar 

  18. Sreepada, T. K. et al. Prospective study of cyclosporin in refractory nephrotic syndrome in adults: preliminary results. Kidney Int. 1987: 31, 214.

    Google Scholar 

  19. Balcke, P. et al. Cyclosporin A treatment of patients with minimal change nephritis. Wien, Klin. Wschr. 1987: 99, 242–245.

    CAS  Google Scholar 

  20. DeSanto, N. G., Capodicasa, G., Giordano, C. Treatment of idiopathic membranous nephropathy unresponsive to methylpredni-solone and chlorambucil with cyclosporin. Am. J. Nephrol. 1987: 7, 74–76.

    PubMed  CAS  Google Scholar 

  21. Chan, M. K. and Cheng, I. K. P. Cyclosporin in steroid-sensitive frequent relapsing nephrotic syndrome. Postgrad. Med. J. 1987: 63, 757–759.

    Article  PubMed  CAS  Google Scholar 

  22. Millet, V. G. et al. Cyclosporin A in minimal change nephrotic syndrome. Kidney Int. 1987: 3, 614.

    Google Scholar 

  23. Zietse, R. et al. Cyclosporin A in patients with nephrotic syndrome. Kidney Int. 1988: 33, 1035.

    Google Scholar 

  24. Berthoux, F. C. et al. Cyclosporin in the treatment of nephrotic syndrome. Nephrol Dial Transplant. 1987: 2, 412.

    Google Scholar 

  25. Heule, H. et al. Treatment of severe nephrotic syndrome with cyclosporin A. Nephrol Dial Transplant 1987: 2, 415.

    Google Scholar 

  26. Kuhn, K. et al. Cyclosporin treatment for nephrotic syndrome. Nephrol Dial Transplant. 1987: 2, 416.

    Google Scholar 

  27. Meyrier, A. Cyclosporin A in the treatment of idiopathic nephrotic syndrome. Springer Semin. Immunopathol, 1987: 441-450.

  28. Meyrier, A. et al. Cyclosporin treatment of refractory idiopathic nephrotic syndrome in adults: results of the French Collaborative Study. Transplant Proc. 1988, Suppl. 4 (Book III), 259–261.

  29. The Cooperative Study of the Spanish Society of Nephrology. Cyclosporin in glomerulonephritis. Nefrologia 1988: Vol. VIII, Suppl. 1, 15–23.

    Google Scholar 

  30. Schulz, A. W. et al. Treatment of nephrotic syndrome with cyclosporin A. Kidney Int. 1988: 34, 576.

    Google Scholar 

  31. Clasen, W. et al. Long-term treatment of nephrotic patients with cyclosporin A. Nephrol Dial Transplant 1988: 3, 733–737.

    PubMed  CAS  Google Scholar 

  32. Maher, E. R. et al. Cyclosporin A in the treatment of steroid-responsive and steroid-resistant nephrotic syndrome in adults. Nephrol Dial Transplant. 1988: 3, 728–732.

    PubMed  CAS  Google Scholar 

  33. Lai, K. N., Lai, F. M. and Vallance-Owen, J. A short-term controlled trial of cyclosporin A in IgA nephropathy. Trans. Proc. 1988: Vol. XX, No. 3, Suppl. 4, 297–303.

    Google Scholar 

  34. Praga, M. et al. Cyclosporin A induced acute renal failure in the nephrotic syndrome: a case report. Ann, Int. Med. 1987: 107, 786–787.

    CAS  Google Scholar 

Download references

Author information

Author notes

  1. A. Green

    Present address: MRC Molecular Genetics Unit, Level 5, Addenbrook’s Hospital, Hill Road, CB1 5HB, Cambridge, U.K.

Authors and Affiliations

  1. Departments of Nephrology and Pathology, Beaumont Hospital, Dublin 9

    A. Green, Y. O’Meara, J. Sheehan, M. Carmody, G. Doyle & J. Donohoe

Authors
  1. A. Green
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Y. O’Meara
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. J. Sheehan
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. M. Carmody
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. G. Doyle
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. J. Donohoe
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. A. Green
    View author publications

    You can also search for this author in PubMed Google Scholar

Rights and permissions

Reprints and permissions

About this article

Cite this article

Green, A., O’Meara, Y., Sheehan, J. et al. The use of cyclosporin a in adult nephrotic syndrome: Nine cases and literature review. I.J.M.S. 159, 178–181 (1990). https://doi.org/10.1007/BF02937238

Download citation

  • Issue Date:

  • DOI: https://doi.org/10.1007/BF02937238

Keywords

Search

Navigation