Abstract
Cyclosporin A (CyA) is now commonly used in the management of children with steroid-dependent nephrotic syndrome. In order to assess nephrotoxicity related to CyA therapy, we measured glomerular filtration rate (GFR) on 123 occasions in 24 children with minimal change nephrotic syndrome receiving CyA. GFR was estimated from the plasma clearance of51chromium-EDTA every 3 months during CyA therapy of up to 27 months duration. There was a significant reduction in GFR after 3 months of CyA therapy [118±33 (SD) to 93±24 ml/min per 1.73 m2] but no further fall thereafter, although the reduction in GFR was sustained for the duration of CyA therapy. This reduction in GFR appeared to be reversible upon cessation of CyA, but careful monitoring of renal function is necessary in such patients to prevent the development of longer term nephrotoxic sequelae.
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References
Collaborative Study Group of Sandimmun in Nephrotic Syndrome (1991) Safety and tolerability of cyclosporin A (Sandimmun) in idiopathic nephrotic syndrome. Clin Nephrol 35: S48-S60
Niaudet P, Broyer M, Habib R (1991) Treatment of idiopathic nephrotic syndrome with cyclosporin A in children. Clin Nephrol 35: S31-S36
Trompeter RS (1989) Immunosuppressive therapy in the nephrotic syndrome in children. Pediatr Nephrol 3: 194–200
Mason J (1990) The pathophysiology of Sandimmune (cyclosporine) in man and animals. Pediatr Nephrol 4: 554–574
Thomson SC, Tucker BJ, Gabbai F, Blantz RC (1989) Functional effects on glomerular hemodynamics of short-term chronic cyclosporine in male rats. J Clin Invest 83: 960–969
Winston JA, Feingold R, Safirstein R (1989) Glomerular hemodynamics in cyclosporine nephrotoxicity following uninephrectomy. Kidney Int 35: 1175–1182
Murray BM, Paller MS, Ferris TF (1985) Effect of cyclosporine administration on renal hemodynamics in conscious rats. Kidney Int 28: 767–774
Balletta M, Libetta C, Fuiano G, Delfino M, Brunetti B, Ungaro B, Conte G (1991) Effects of a two-month treatment with low oral doses of cyclosporin on renal function. Nephrol Dial Transplant 6: 324–329
Hulton S-A, Neuhaus TJ, Dillon MJ, Barratt TM (1994) Long-term cyclosporin A treatment of minimal-change nephrotic syndrome of childhood. Pediatr Nephrol (in press)
Sawchuk RJ, Cartier LL (1981) Liquid chromatographic determination of cyclosporin A in blood and plasma. Clin Chem 27: 1368–1371
Chantler C, Barratt TM (1972) Estimation of glomerular filtration rate from plasma clearance of 51-chromium edetic acid. Arch Dis Child 47: 613–617
Trompeter RS, Barratt TM (1988) Treatment and management of the nephrotic syndrome in children. In: Cameron JS, Glassock RJ (eds) The nephrotic syndrome. Dekker, New York, pp 423–431
Myers BD, Ross J, Newton L, Luetscher J, Perlroth M (1984) Cyclosporine-associated chronic nephropathy. N Engl J Med 311: 699–705
Greenberg A, Thompson ME, Egel JW (1987) Early and late forms of cyclosporin nephrotoxicity: studies in cardiac transplant recipients. Am J Kidney Dis 9: 12–22
Dodge WF, Travis LB, Daeschner CW (1967) Comparison of endogenous creatinine clearance with inulin clearance. Am J Dis Child 113: 683–684
Zeitze R, Wenting GJ, Kramer P, Schalekamp MA, Weimar W (1992) Effects of cyclosporin A on glomerular barrier function in the nephrotic syndrome. Clin Sci 82: 641–650
Puschett JB, Greenberg A, Holley J, McCauley J (1990) The spectrum of ciclosporin nephrotoxicity. Am J Nephrol 10: 296–309
McNally PG, Feehally J (1992) Pathophysiology of cyclosporin A nephrotoxicity: experimental and clinical observations. Nephrol Dial Transplant 7: 791–804
Tirelli AS, Paterlini G, Ghio L, Edefonti A, Assael BM, Bettinelli A, Cavanna G, Sereni F (1993) Renal effects of cyclosporin A in children treated for idiopathic nephrotic syndrome. Acta Paediatr 82: 463–468
Neuhaus TJ, Burger HR, Klingler M, Fanconi A, Leumann EP (1992) Long-term low-dose cyclosporin A in steroid dependent nephrotic syndrome of childhood. Eur J Pediatr 151: 775–778
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Hulton, SA., Jadresic, L., Shah, V. et al. Effect of cyclosporin A on glomerular filtration rate in children with minimal change nephrotic syndrome. Pediatr Nephrol 8, 404–407 (1994). https://doi.org/10.1007/BF00856512
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DOI: https://doi.org/10.1007/BF00856512