LONG-TERM CYCLOSPORINE THERAPY IN CHILDRE N WITH NEPHROTIC SYNDROME

Cyclosporine is an alternative therpy in nephrotic children having pro teinuria unresponsive to conventional treatment. The effects of sustai ned administration of cyclosporine in this group of patients are scarc ely known. We studied 10 male children, aged from 2 years 10 months to 11 years 3 months, treated with cyclosporine over a period longer tha n 12 months ((X) over bar +/- SEM: 26 +/- 3 months) because of nephrot ic syndrome either steroid-resistant or dependent on high doses of est eroids (4 minimal change nephropathies and 6 IgM glomerulonephritis). Ciclosporine was started at a dose of 4-5 mg/kg/day and dosages adjust ed to maintain blood levels between 70 and 120 ng/ml. All children had received treatment with prednisone and cyclophosphamide. Cyclosporine therapy significantly (p < 0,001) increased the percentage of protein uria-free time from 20.1 +/- 1.0 to 73.7 +/- 0.9%. The beneficial acti on on proteinuria was not associated with important undesirable clinic al analytical side effects. Inverse correlation between albuminemia an d hypercholesterolemia remained unchanged. Children grew better under cyclosporine treatment as shown by an increase (p < 0.01) in height Z score irom -0.29 +/- 0.34 to +0.06 +/- 0.35. This improvement was prob ably related to the lower cumulative prednisone dose received by the c hildren while they were on cyclosporin (504 +/- 80 vs 199 +/- 30 mg/pa tient/month). Thus, sustained treatment with cyclosporin resulted in a better control of proteinuria and acceleration of growth without impo rtant toxocity, either clinical or on laboratory tests.