Initial remission-inducing effect of very low-dose cyclosporin monotherapyfor minimal-change nephrotic syndrome in Japanese adults

Aim: Cyclosporin A (CsA) in combination with corticosteroids can be used ef fectively in steroid-sensitive nephrotic syndrome. However, reports documen ting the effectiveness of CsA monotherapy against such a condition have bee n scarce. In 11 adults with minimal-change nephrotic syndrome, we have trie d very low-dose CsA in the hope of inducing remission without using either corticosteroid or any other immunosuppressive drugs. Patients and methods: Indications for treatment included steroid-sensitive relapsing nephrotic sy ndrome (7 patients) and first-episode nephrotic syndrome (4 patients). In a ll patients, corticosteroid and cytotoxic agents had not been given before entry. CsA was administered orally at an initial dose of 2.4 (range 1.5-3.1 ) mg/kg per day. Results: Analysis of the clinical course revealed that 8 o f I I patients entered complete remission after a mean duration of 44 +/- 3 1 days, whereas 3 patients failed to enter remission to CsA alone, resultin g in complete remission combined with methylprednisolone pulse therapy with out conventional oral prednisolone. CsA dosages and trough levels between r esponders and non-responders were similar. non-responders had much higher l evels of serum total cholesterol and higher daily urinary excretion of prot ein than those of responders, respectively. No patients had significant dec rease in creatinine clearance, development of hypertension or suffered from other CsA associated serious side-effects. Conclusion: The present data su ggest that CsA monotherapy at a very low dose could induce complete remissi on in adult patients with minimal-change nephrotic syndrome. Conversely, se vere hypercholesterolemia would be likely to inhibit the action of CsA agai nst nephrotic conditions.