스테로이드 의존성 소아 신증후군에서 Cyclosporine의 치료 효과 및 안전성
Efficacy and Safety of Cyclosporine in Children with Steroid-Dependent Nephrotic Syndrome
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Background : Idiopathic nephrotic syndrome is usually responsive to steroid treatment, however, repeated and prolonged use of steroids may result in poor growth, osteoporosis, and cataracts. In order to reduce steroid adverse reactions and to maintain remission, cyclosporine (CsA) is used as a corticosteroid- sparing agent for steroid-dependent nephrotic syndrome (SDNS) patients. This retrospective study was undertaken to investigate the efficacy and safety of one-year CsA therapy in SDNS children. Methods : Thirty-five children with SDNS, who were treated with CsA from July 2006 to July 2017, were included in this study. The primary endpoints were defined as the number of relapse episodes and the improvement of clinical symptoms, whereas the secondary endpoints were recognized as the cumulative dose of steroids, adverse drug reactions and nephrotoxicity of CsA. Results : After one-year treatment, 31 (88.6%) of the 35 patients achieved complete remission and 2 (5.7%) achieved partial remission. Fourteen (40.0%) patients did not relapse during the study. The number of relapse episodes during the CsA therapy was significantly lower than that in the preceding year (P=0.01). Although hirsutism, abdominal pain, and gingival hypertrophy were observed during the therapy, none of these was sufficiently severe to cause discontinuation of treatment. Blood urea nitrogen (BUN) and serum creatinine (SCr) levels after the therapy were similar to those at the time of study entry (P=0.831, 0.056). Conclusions : One-year treatment with CsA was effective and safe for children with steroid-dependent nephrotic syndrome. However, further long-term prospective studies in multiple centers are necessary to demonstrate the efficacy and safety of CsA.
Abstract
Background : Idiopathic nephrotic syndrome is usually responsive to steroid treatment, however, repeated and prolonged use of steroids may result in poor growth, osteoporosis, and cataracts. In order to reduce steroid adverse reactions and to maintain remission, cyclosporine (CsA) is used as a corticosteroid- sparing agent for steroid-dependent nephrotic syndrome (SDNS) patients. This retrospective study was undertaken to investigate the efficacy and safety of one-year CsA therapy in SDNS children. Methods : Thirty-five children with SDNS, who were treated with CsA from July 2006 to July 2017, were included in this study. The primary endpoints were defined as the number of relapse episodes and the improvement of clinical symptoms, whereas the secondary endpoints were recognized as the cumulative dose of steroids, adverse drug reactions and nephrotoxicity of CsA. Results : After one-year treatment, 31 (88.6%) of the 35 patients achieved complete remission and 2 (5.7%) achieved partial remission. Fourteen (40.0%) patients did not relapse during the study. The number of relapse episodes during the CsA therapy was significantly lower than that in the preceding year (P=0.01). Although hirsutism, abdominal pain, and gingival hypertrophy were observed during the therapy, none of these was sufficiently severe to cause discontinuation of treatment. Blood urea nitrogen (BUN) and serum creatinine (SCr) levels after the therapy were similar to those at the time of study entry (P=0.831, 0.056). Conclusions : One-year treatment with CsA was effective and safe for children with steroid-dependent nephrotic syndrome. However, further long-term prospective studies in multiple centers are necessary to demonstrate the efficacy and safety of CsA.
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