THERAPY OF FOCAL AND SEGMENTAL GLOMERULOSCLEROSIS WITH METHYLPREDNISOLONE, CYCLOSPORINE-A, AND PREDNISONE

Patients with steroid-resistant focal and segmental glomerulosclerosis (FSGS) have a poor prognosis but may benefit from high-dose methylpre dnisolone or cyclosporine A therapy. Ten patients were treated with a protocol of methylprednisolone infusions for 8 weeks followed by a com bination of cyclosporine A and alternate-day prednisone for maintenanc e of remission for 2 weeks. Eight of ten patients remitted the nephrot ic syndrome within 8 weeks of beginning treatment. One patient remitte d edema but remained proteinuric, and one did not respond. After obser vation for 12-24 months, seven patients maintained remission with norm al glomerular filtration rate. One non-responder had renal insufficien cy and one patient had secondary non-response and end-stage renal dise ase. No patients developed hypertension. One patient had the diagnosis of Hodgkin disease made after 10 months of therapy. Follow-up renal b iopsy in four patients showed no evidence of progressive interstitial disease, There were no other major side effects. Steroid-resistant FSG S may be successfully treated with the described protocol. Additional studies will be needed to determine if this approach prevents progress ion of renal disease.