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Nephrotoxicity of once-daily cyclosporine A in minimal change nephrotic syndrome

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Abstract

Background

Although once-daily cyclosporine (CsA) therapy may have greater nephrotoxic-sparing effects than standard twice-daily therapy, little information is available in children with steroid-dependent minimal change nephrotic syndrome (MCNS) regarding histological analysis after long-term once-daily administration.

Case-Diagnosis/Treatment

A prospective study of the clinical efficacy and comparison between pre- and post-treatment renal biopsy findings in ten children (mean age, 8.8 years) with steroid-dependent MCNS who were administered once-daily CsA therapy for more than 24 months (mean ± SD, 30 ± 3.7) was performed in Saitama Children’s Medical Center. Administration of once-daily CsA therapy (mean dose, 2.8 ± 0.6 mg/kg/day; mean C2 levels, 670 ± 64 ng/ml) resulted in a significant reduction in the median relapse rate from 4.6 to 0.2 times per year, and five patients did not experience a relapse of NS. Furthermore, mean threshold of prednisolone dose significantly reduced from 1.2 to 0.02 mg/kg on alternate days. However, two patients showed evidence of chronic CsA nephrotoxicity (CsAN).

Conclusions

Once-daily CsA therapy appears to be effective in children with steroid-dependent MCNS. However, follow-up renal biopsies should be performed to investigate the presence of CsAN after more than 24 months of treatment with once-daily regimen as well as with the conventional twice-daily regimen.

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Authors and Affiliations

  1. Division of Nephrology, Saitama Children’s Medical Center, 2100 Magome, Iwatsuki-ward, Saitama-city Saitama, 339 8551, Japan

    Shuichiro Fujinaga & Daishi Hirano

  2. Division of Pathology, Saitama Children’s Medical Center, Saitama, Japan

    Hitohiko Murakami

  3. Department of Pediatrics, Juntendo Nerima Hospital, Tokyo, Japan

    Yoshiyuki Ohtomo

  4. Department of Pediatrics, Juntendo University School of Medicine, Tokyo, Japan

    Toshiaki Shimizu

  5. Department of Pediatrics, Kansai Medical University, Osaka, Japan

    Kazunari Kaneko

Authors
  1. Shuichiro Fujinaga
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  2. Daishi Hirano
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  3. Hitohiko Murakami
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  4. Yoshiyuki Ohtomo
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  5. Toshiaki Shimizu
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  6. Kazunari Kaneko
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Corresponding author

Correspondence to Shuichiro Fujinaga.

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Fujinaga, S., Hirano, D., Murakami, H. et al. Nephrotoxicity of once-daily cyclosporine A in minimal change nephrotic syndrome. Pediatr Nephrol 27, 671–674 (2012). https://doi.org/10.1007/s00467-011-2076-6

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  • DOI: https://doi.org/10.1007/s00467-011-2076-6

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