Treatment of adult idiopathic nephrotic syndrome with cyclosporin A: minimal-change disease and focal-segmental glomerulosclerosis. Collaborative Group of the French Society of Nephrology

Abstract

Two open studies were conducted to determine the efficacy and tolerance of cyclosporin A (CyA, Sandimmun) 5 mg/kg/day. Sixty-four patients received CyA as monotherapy, and efficacy was assessed at three months; in 48 other patients, CyA was given with prednisone 12-15 mg/kg/day, and efficacy was assessed at six months. Of these 112 patients, 14 withdrew prematurely because of adverse events or other reasons, and a further nine patients were excluded for protocol violation. The remaining 98 patients were considered valid for the evaluation of efficacy (52 with minimal-change disease [MCD] and 46 with focal-segmental glomerulosclerosis [FSGS]; 37/98 were steroid-dependent [SD], and 61/98 were steroid-resistant [SR]). The remission:failure rate depended on histology (36:16 in MCD, 11:35 in FSGS) and steroid response (25:12 in SD, 22:39 in SR). The rate of remission was highest in SD MCD (71%) and lowest in SR FSGS (20%; chi square = 18.6, p less than 0.001). Tolerance was assessed by serum creatinine and, in 36 cases, by repeat renal biopsy at six to 42 months. Serum creatinine was remarkably stable in MCD. Rising creatinines were observed mostly in cases of SR FSGS, particularly those who had pretreatment interstitial lesions; this was considered due to both an increase of interstitial lesions and progression of the glomerular lesions of FSGS.(ABSTRACT TRUNCATED AT 250 WORDS)