Korean Journal of Nephrology 1992;11(4):359-369.

성인 미세변화신증후군에서의 Cyclosporine의 치료 효과 - Multicenter Study in Korea -

강종명 , 김성권 , 이호영 , 이정상 , 김명재

Abstract

We treated 16 steroid dependent, steroid resistant and frequently relapsing minimal change nephrotic syn- drome, 2 focal segmental glomerulosclerosis and 2 other glomerulonephritis patients with oral cyclosporine for 8 months. Cyclosporine was started at an initial dose of 5 mg/kg/day in two divided doses along with 10 mg of prednisolone. Of these 20 patients, 2 withdrew early from study for reasons other than complications of cyclosporine treatment. The efficacy of cyclosporine was evaluated in remaining 18 patients. Cyclosporine induced a complete remission in 14 patients, partial remission in two, and failed in 4 patients. Complete remission occurred in 5±1.2 weeks (range 2-16 weeks) of treatment. There was no correlation between the previous response to steroid and the efficacy of cyclosporine. Cyclosporine was much effective in mini- mal change nephrotic syndrome. We obtained complete remission in 14 out of 16, namely, 87% of minimal change nephrotic syndrome and failed to induce remis- sion in only 2 patients. On the other hand, only one patient with focal segmental glomerulosclerosis entered partial remission and the other one failed. 24 hour urinary protein excretion pmoptly improved with cyclosporine treatment. It fell from 11,76g to 5,02 g within 2 weeks of treatment and to nadir, 0,44 g at 5 months, and slightly rose thereafter up to the end of the study. Tolerence to the treatment was excellent. Minor side effect, such as gum hypertrophy, hypertrichosis and hyperbilirubinemia were reported in small number of patints, but these were not serious enough to interrupt the study. Blood pressure and the serum creatinine level were stable througout the study in most of the patients. Twelve out of 16 patients who were in remission with cyclosporine treatment relpased after withdrwal of cyclosprine. The relapse rate was 75%. Relapse occur- red in 4.5±0.7 weeks (range 1-14 weeks) after stop- ping cyclosporine. In conclusion, cyclosporine is a good alternative to steroids in the treatment of minimal change nephrotic syndrome, particularly in steroid dependetnt and fre- quent relapsers who are at risk of developing steroid toxicity. Cyclosporine needs to be administered for a long periods of time in these patients because of the high incidence of relapses on withdrawal of cyclosporine. Consequently, close monitoring of renal function is required to prevent renal functional impairement.