Cyclosporine treatment of glomerular diseases

Cyclosporine-A is primary therapy for organ transplantation. Its immunosupp ressive effect might suggest a therapeutic role in autoimmune diseases, inc luding several idiopathic and secondary glomerular conditions. Various farm s of idiopathic nephrotic syndrome, including focal segmental glomeruloscle rosis (FSGS), minimal change disease (MCD), and membranous nephropathy (MN) , may respond well to cyclosporine in selected patients. However, frequent relapse limits its use to those who have failed to respond to, or were into lerant of, steroids or cytotoxics. Cyclosporine's efficacy in other glomeru lopathies, such as IgA nephropathy (IgAN) and membranoproliferative glomeru lonephritis (MPGN) remains poorly studied and, given the risk of nephrotoxi city, cannot be recommended for treatment of these entities until further d ata are available. Cyclosporine demonstrates some efficacy in treating prol iferative lupus nephritis and, based on pilot study data, membranous lupus as well. Again, given relapse rates and potential nephrotoxicity, it should be used only in combination with azathioprine and steroids, assuming cytot oxic therapy has failed. Finally, cyclosporine toxicity is briefly reviewed .