LONG-TERM CYCLOSPORIN-A TREATMENT IN ADULTS WITH MINIMAL CHANGE NEPHROTIC SYNDROME OR FOCAL SEGMENTAL GLOMERULOSCLEROSIS

To evaluate the efficacy and safety of long-term ciclosporine A (CSA) treatment in idiopathic nephrotic syndrome, we prospectively followed immunosuppressive therapy in 22 nephrotic adults for a median of 32 mo nths (range 7-91 months) and obtained repeat renal biopsies. CSA induc ed complete remission in 60.0% and 14.3% of patients with minimal chan ge nephrotic syndrome (MCNS) (n = 7), respectively. In addition, parti al remissions were achieved in 20.0% of patients with MCNS and in 42.9 % of patients with FSGS. Resolution of proteinuria was strictly CSA-de pendent and no sustained remission occurred following withdrawal, ther eby requiring long-term treatment in 18 patients. In 10 patients CSA w as administered for more than 43 months. During maintenance therapy th e antiproteinuric effect of CSA was preserved and renal function as we ll as blood pressure remained stable in patients with MCNS, whereas re nal function deteriorated in two patients with FSGS due to progression of the underlying renal disease. Renal biopsies revealed slight signs of CSA toxicity in four patients. However, in no case loss of renal f unction was attributable to these lesions. In conclusion, the present data suggest that long-term maintenance treatment of MCNS with CSA is efficacious and safe at least for a period of up to 43 months. In cont rast, CSA has some effect on proteinuria in FSGS, but the results are less favorable.