Combined cyclosporine and prednisolone therapy in adult patients with the first relapse of minimal-change nephrotic syndrome

Nephrol Dial Transplant. 2010 Jan;25(1):124-9. doi: 10.1093/ndt/gfp422. Epub 2009 Sep 9.

Abstract

Background: Although minimal-change nephrotic syndrome (MCNS) is highly steroid-responsive, some patients show frequent relapses, necessitating administration of repeated courses of prednisolone (PSL) at high doses. The adverse effects of long-term PSL treatment include osteoporosis, infection, diabetes, cataract, etc., most of which are serious. It is therefore necessary to establish useful strategies to reduce the PSL dose.

Methods: Patients with the first relapse of MCNS were randomly assigned to two groups, namely, the CyA (AUC 1700-2000 ng/ml) + PSL (0.8 mg/kg/day) group (n = 26) and the PSL alone (PSL) (1.0 mg/kg/day) group (n = 26), and the clinical characteristics were compared between the two groups. All patients used C2 for CyA monitoring.

Results: A significant decrease of the urinary protein excretion (P = 0.02) and serum total cholesterol (P = 0.003) was observed at 2 weeks from the first relapse in the CyA + PSL group. The increase in the serum total protein (P = 0.03) and serum albumin (P = 0.007) as compared with that in the PSL group was also observed in the CyA + PSL group at this time-point. The time to remission in the CyA + PSL group was shorter than that in the PSL group (P = 0.006).

Conclusion: It was possible to obtain early remission and reduce the PSL dose with combined CyA and PSL therapy in patients with MCNS.

Publication types

  • Randomized Controlled Trial

MeSH terms

  • Adult
  • Cholesterol / blood
  • Cyclosporine / therapeutic use*
  • Dose-Response Relationship, Drug
  • Drug Therapy, Combination
  • Female
  • Glucocorticoids / adverse effects
  • Glucocorticoids / therapeutic use*
  • Humans
  • Immunosuppressive Agents / therapeutic use*
  • Male
  • Nephrosis, Lipoid / blood
  • Nephrosis, Lipoid / drug therapy*
  • Nephrosis, Lipoid / urine
  • Prednisolone / adverse effects
  • Prednisolone / therapeutic use*
  • Proteinuria / metabolism
  • Recurrence
  • Remission Induction
  • Treatment Outcome

Substances

  • Glucocorticoids
  • Immunosuppressive Agents
  • Cyclosporine
  • Cholesterol
  • Prednisolone