Nephrotoxicity in children with frequently relapsing nephrotic syndrome receiving long-term cyclosporine treatment.
Background: Steroid-sparing drugs, such as cyclosporine, are recommended as treatment for children with frequently relapsing nephrotic syndrome (FRNS) and steroid-related toxicities. We recently reported a high rate of relapsing nephrotic syndrome 2 years after discontinuation of cyclosporine treatm...
| Publicado en: | Pediatric Nephrology Vol. 32; no. 8; pp. 1383 - 1391 |
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| Autores principales: | , , , , , , , , |
| Formato: | research tables/charts Journal Article |
| Publicado: |
Springer Nature
Aug2017
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| Acceso en línea: | Ver este registro en EBSCOhost |
| fields | @attributes: recordID: 1 pdfLink: plink: https://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=123732602&site=ehost-live header: @attributes: shortDbName: ccm uiTerm: 123732602 longDbName: CINAHL Complete uiTag: AN controlInfo: bkinfo: dissinfo: jinfo: jid: 0931041X EF1 jtl: Pediatric Nephrology issn: 0931041X maglogo: N pubinfo: dt: Aug2017 vid: 32 iid: 8 pid: 237 pub: Springer Nature place: New York, New York artinfo: ui: 123732602 123732602 143999215 123732602 10.1007/s00467-017-3641-4 123732602 ppf: 1383 ppct: 8 formats: fmt: @attributes: type: P tig: atl: Nephrotoxicity in children with frequently relapsing nephrotic syndrome receiving long-term cyclosporine treatment. aug: au: Hamasaki, Yuko Komaki, Fumiyo Ishikura, Kenji Hamada, Riku Sakai, Tomoyuki Hataya, Hiroshi Ogata, Kentaro Ando, Takashi Honda, Masataka affil: Division of Infectious Diseases Control , Health and Welfare Bureau Health Center of Kawasaki City , Kanagawa Japan sug: subj: Cyclosporine Administration and Dosage Nephrotic Syndrome Drug Therapy Nephrotoxicity Etiology Cyclosporine Adverse Effects Recurrence Drug Therapy Human Treatment Duration Retrospective Design Fibrosis Descriptive Statistics Male Female Child Arteries Pathology Odds Ratio Confidence Intervals Biopsy Drug Monitoring Child: 6-12 years Male Female ab: Background: Steroid-sparing drugs, such as cyclosporine, are recommended as treatment for children with frequently relapsing nephrotic syndrome (FRNS) and steroid-related toxicities. We recently reported a high rate of relapsing nephrotic syndrome 2 years after discontinuation of cyclosporine treatment, suggesting that long-term treatment is necessary. Cyclosporine-associated nephrotoxicity (CAN) is a potential side effect of long-term cyclosporine treatment. Methods: We retrospectively reviewed pediatric patients with FRNS treated with cyclosporine for ≥3 years at a single center between 1999 and 2012. The cyclosporine dose was adjusted to maintain the whole-blood cyclosporine trough level at 80-100 ng/ml for 6 months, at 60-80 ng/ml for 18 months, and then at around 50-60 ng/ml thereafter. Maintenance dose of prednisolone was not prescribed. CAN was graded in terms of arteriolar hyalinosis and the degree of interstitial fibrosis. Results: Thirty-six children (28 males) were enrolled in the study. The median age at the start of long-term cyclosporine treatment was 9.4 years. The median duration of the longest period of cyclosporine treatment was 4.5 years. Most CAN cases were characterized by arteriolar hyalinosis. The frequency of CAN was positively correlated with the duration of cyclosporine treatment, with an odds ratio (95% confidence interval) for CAN of 3.84 (0.79-18.74) after 2-5 years and 6.60 (1.18-36.94) after >5 years of cyclosporine treatment (vs. 0-2 years). Conclusions: Although the frequency of CAN was correlated with the duration of cyclosporine treatment in our pediatric patient population, most cases of CAN involved arteriolar hyalinosis. We conclude that long-term cyclosporine treatment is useful for treating FRNS in children, providing its dose is controlled and kidney biopsies are regularly performed. pubtype: Academic Journal doctype: research tables/charts Journal Article ougenre: Article language: English refInfo: holdings: @attributes: islocal: N |
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