Combination Therapy Consisting of Low-dose Cyclosporin A, Low-dose Prednisolone and Enalapril in Children with Steroid-Sensitive Nephrotic Syndrome

概要

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To evaluate the extent to which combined low-dose cyclosporin A (CsA), low - dose glucocorticoid and enalapril would permit decreasing 1) steroidal toxicity, 2) the frequency of relapse of nephrotic syndrome and 3) adverse effects due to CsA, in children with steroid - dependent nephrotic syndrome. Eight children with steroid-dependent nephrotic syndrome underwent CsA therapy (mean : 2.7 mg/kg/day) for more than 24 months. Renal biopsy was performed at 24 months of CsA treatment. Height development was assessed by comparing with normal level. The changes in prednisolone dosage, as well as in the frequency of relapse, were studied. Prednisolone dosage significantly (p < 0.05) decreased to 0.20 ± 0.14 mg/kg/day after start of CsA therapy, being 0.64 ± 0.35 mg/kg/day before it. The frequency of relapse significantly (p < 0.05) decreased to 0.13 ± 0.12 times per month after start of CsA therapy, its initial frequency being 0.48 ±0.11 times per month. There were no severe histological abnormalities. The height development delay was progressed in only one patient. There were no adverse effects of CsA. It may be safely said that low-dose CsA (2.5〜3.0 mg/kg) was effective in pediatric steroid-dependent nephrotic syndrome and that the trough levels of CsA of 100 to 150 ng/ml were not necessary when combined with low - dose prednisolone which would not induce major side effects.
獨協医科大学の論文
2003-10-25