J Korean Med Sci.  2010 May;25(5):723-727. 10.3346/jkms.2010.25.5.723.

Effects of Cyclosporin A Therapy Combined with Steroids and Angiotensin Converting Enzyme Inhibitors on Childhood IgA Nephropathy

• Shin JI
• Lim BJ
• Kim PK
• Lee JS
• Jeong HJ
• Kim JH

• KMID: 1713956
• DOI: http://doi.org/10.3346/jkms.2010.25.5.723

Abstract

To evaluate the effects of cyclosporin A (CyA) on clinical outcome and pathologic changes in children with IgA nephropathy (IgAN), we retrospectively evaluated 14 children (mean age 8.9+/-2.9 yr; eight males, six females) who were treated with CyA and steroids. The starting dose of CyA was 5 mg/kg per day, and the drug level was maintained at 100-200 ng/mL. The mean CyA level was 183.8+/-48.3 ng/mL (range 120.7-276.0 ng/mL) and the mean duration of CyA therapy was 10.9+/-1.9 months (range 8-12 months). After CyA therapy the mean 24 hr urinary protein excretion declined from 107.1+/-35.1 mg/m2/hr to 7.4+/-2.4 mg/m2/hr (P<0.001) and serum albumin increased from 3.3+/-0.6 g/dL to 4.3+/-0.3 g/dL (P<0.001). At a follow-up biopsy the histological grade of IgAN was improved in seven (50%) of the 14 patients, remained the same in three (21%), and was aggravated in four (29%). Serum creatinine, creatinine clearance, and blood pressure did not differ before and after CyA therapy. Two patients (14%) showed CyA-induced nephrotoxicity at the second biopsy. Our findings indicate that CyA therapy may be effective in reducing proteinuria and regressing renal pathology in a subset of children with IgAN.

Keyword

Glomerulonephritis, IGA; Cyclosporine; Heavy Proteinuria; Child

MeSH Terms

Angiotensin-Converting Enzyme Inhibitors/*administration & dosage
Child
Cyclosporine/*administration & dosage
Drug Combinations
Female
Glomerulonephritis, IGA/*diagnosis/*drug therapy
Humans
Immunosuppressive Agents/administration & dosage
Male
Steroids/*administration & dosage
Treatment Outcome
Angiotensin-Converting Enzyme Inhibitors
Drug Combinations
Immunosuppressive Agents
Steroids
Cyclosporine

Figure

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  Fig. 1 Clinical state at presentation and at final visit.

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  Fig. 2 Urinary protein excretion before and after cyclosporin therapy.

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