Recovery from cyclosporine-associated arteriolopathy in childhood nephrotic syndrome

Cyclosporine (CS) is well recognized to be effective in the treatment of ch ildren with steroid-dependent and steroid-resistant nephrotic syndrome (NS) , but its use can result in chronic nephrotoxicity. The histological change s that occur after CS discontinuation are unknown. Therefore, we examined t he histological changes [CS-associated arteriolopathy (CAA), tubulointersti tial lesions, and focal glomerular lesions] in renal biopsy specimens after the drug had been discontinued in eight children with idiopathic nephrotic syndrome (NS). These children had been treated with long-term moderate-dos e CS and had shown mild-to-moderate chronic CS nephrotoxicity. The degree o f CAA improved significantly after CS discontinuation (mean CAA grade from 1.30+/-0.46 to 0.25+/-0.46, P=0.028). CAA disappeared in six of these child ren after CS discontinuation. However, the tubulointerstitial lesions and t he focal glomerular lesions did not change after CS discontinuation. In con clusion, in children with idiopathic NS, CAA is improved by discontinuation of CS, but tubulointerstitial changes and focal glomerular lesions do not regress with drug discontinuation.