Cyclosporin in idiopathic glomerular disease associated with the nephrotic syndrome : workshop recommendations.

Abstract:

:Management of idiopathic glomerular disease associated with nephrotic syndrome (INS) remains controversial and one of the most complex areas relates to utilization of the drug cyclosporin. This is despite its demonstrated effectiveness in several histologic types of the INS in randomized controlled trials. Cyclosporin is effective in inducing remission of proteinuria in approximately 80% of steroid-sensitive cases of minimal change disease (MCD). Cyclosporin is also effective in both the induction of remission and long-term preservation of renal function in steroid-dependent/-resistant MCD and steroid-resistant focal segmental glomerulosclerosis (FSGS). The overall response rate in FSGS is lower than in MCD, and long-term therapy (>12 months) may be required to both achieve remission and sustain it. Cyclosporin therapy is also of benefit in reducing proteinuria in 70-80% of patients with steroid-resistant membranous nephropathy (MGN). In MGN, the maximum benefit is often delayed compared to MCD (>12 weeks). Cyclosporin is generally well tolerated and safe. The major concern remains the nephrotoxicity, but with careful monitoring of the patient's renal function; minimizing the maintenance dose and utilizing repeat renal biopsy in those receiving long-term therapy, this risk can be minimized. The algorithms have been developed derived from the best evidence in the literature in each of the histologic types to help provide a guide to the integration of cyclosporin into the management of INS for the practicing nephrologist.

journal_name

Kidney Int

journal_title

Kidney international

authors

Cattran DC,Alexopoulos E,Heering P,Hoyer PF,Johnston A,Meyrier A,Ponticelli C,Saito T,Choukroun G,Nachman P,Praga M,Yoshikawa N

doi

10.1038/sj.ki.5002553

subject

Has Abstract

pub_date

2007-12-01 00:00:00

pages

1429-47

issue

12

eissn

0085-2538

issn

1523-1755

pii

S0085-2538(15)52590-8

journal_volume

72

pub_type

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