EFFICACY AND NEPHROTOXICITY OF LONG-TERM TREATMENT WITH CYCLOSPORINE IN ADULTS WITH IDIOPATHIC NEPHROTIC SYNDROME

Treatment with ciclosporin (CsA) induces remissions in patients with m inimal change nephrotic syndrome (MCGN) or focal segmental glomerulosc lerosis (FSGN), however, maintenance therapy is required in most cases to stabilize the treatment effect. This prospective study investigate d the safety and efficacy of the long-term use of CsA in the treatment of MCGN and FSGN. CsA induced complete remission in 57.1% and 16.6% o f adult nephrotic patients with MCGN (n = 14) or FSGN (n = 6), respect ively. In addition, partial remissions were achieved in 23.4% of patie nts with MCGN and in 50.0% of patients with FSGN. Resolution of protei nuria was strictly CsA-dependent and no sustained remission occurred f ollowing withdrawal, thus, necessitating long-term treatment in 16 pat ients. During maintenance therapy over a median of 28 (range 6-82) mon ths the overall antiproteinuric effect of CsA was preserved and renal function remained stable in patients with MCGN, whereas renal function deteriorated in two patients with FSGN due to progression of the unde rlying renal disease. There was, however, a rise in diastolic blood pr essure following 36 months of therapy in the MCGN group. Renal biopsie s revealed signs of CsA toxicity in four patients, but in no case loss of renal function was attributable to these lesions. In three patient s with MCGN the antiproteinuric effect of CsA decreased and in these c ases control biopsies revealed glomerular lesions consistent with FSGN . In conclusion, the present data suggest that long-term maintenance t reatment of MCGN or FSGN with CsA is efficacious and safe at least for a period of up to 36 months provided that serial renal biopsies are o btained.