Treatment of idiopathic nephrotic syndrome with cyclosporine A

摘要: Cyclosporine A has been empirically used for more than 12 years in the treatment of idiopathic nephrotic syndrome, both children and adults. There is consistent evidence, from experimental human studies, that highly lipophilic cyclosporine molecule diminishes or abolishes proteinuria by two differing mechanisms. The first its immunosuppressive action, which presumably directed toward secretion a glomerular permeability factor. second appears to be non-immunologic effect on permselectivity, explaining reduced various etiologies syndrome with no immunologic background. success rate inducing remission highest steroid-dependent forms, essentially observed minimal change disease where complete achieved 75% cases. It lowest steroid-resistant especially when accompanied lesions focal segmental glomerulosclerosis, order 20% 25% partial remission. initial dosage adults should not exceed 5.5 mg/kg/day was shown cut-off level toxicity renal biopsy-based studies. slightly higher children, some studies suggest high serum cholesterol levels allow dosages increased rates without additional toxicity. Long-term INS requires serial monitoring function drug reduction creatinine rises 30% over baseline, it recommended carry out biopsy after 1 2 verify absence interstitial fibrosis even though tests are apparently stable. Renal insufficiency and/or severe hypertension complicate approximately 10% cases, FSG, development primary disease, controlled CsA, additive nephrotoxic potential drug. dependency rule during year treatment. However, meaningful number tapering CsA stop low maintenance compatible stable risk nephrotoxicity. Therefore, cyclosporine, main advantage corticosteroid-sparing effect, significant advance syndrome.