Monitoring of Blood Cyclosporine Concentration in Steroid-Resistant Nephrotic Syndrome
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概要
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Objective Cyclosporine has been used for patients with nephrotic syndrome. Because of substantial inter- and intra-patient variability and a narrow therapeutic window, drug monitoring of cyclosporine is mandatory. To confirm the therapeutic effects of a cyclosporine microemulsion (CSAME), the absorption profile of the agent after preprandial administration was determined in steroid-resistant patients with refractory nephrotic syndrome. Methods Fourteen patients were enrolled into the study (mean age, 31.2±12; 6 men, 8 women). The patients received 1.5 mg/kg of cyclosporine 30 minutes before breakfast for 6 months. Blood cyclosporine concentration was measured 5 times serially: before administration (C0) and at 1-hour intervals until 4 hours after administration of cyclosporine (C1-C4). In addition, area under the concentration-time curve from 0-4 hours (AUC0-4) was calculated. Results After 6 months, CSAME showed marked improvement in proteinuria levels (8.3±4.8 g/day vs 0.8±0.4 g/day, p<0.001). No changes in serum creatinine and urea nitrogen levels were observed. In 83% of the patients, the CSAME peak concentration appeared within 1 hour after administration (C1). A strong positive correlation was noted between AUC0-4 and C1 (R2=0.90312) and C2 (R2=0.78431). The mean steroid (prednisolone) dose was 40 mg/day when CSAME treatment was started, but a lowering of the dose to 17.5 mg/day (p<0.001) was achieved at 6 months after CSAME therapy. Conclusion Preprandial administration of CSAME is effective in steroid-resistant patients with refractory nephrotic syndrome. C1 or C2, but not C0, was a good clinical marker for CSAME exposure.
- 社団法人 日本内科学会の論文
著者
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Uchida Keiko
Department of Medicine, Kidney Center, Tokyo Womens Medical University
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Nitta Kosaku
Department of Medicine, Kidney Center, Tokyo Womens Medical University
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TAKEI Takashi
Department of Medicine, Kidney Center, Tokyo Women's Medical University
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TSUCHIYA Ken
Department of Medicine, Kidney Center, Tokyo Women's Medical University
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Tsuchiya Ken
東京女子医科大学附属腎臓病総合医療センター 腎臓内科
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EGUCHI Aya
Department of Medicine, Kidney Center, Tokyo Women's Medical University
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Naito Masayo
Department of Medicine, Kidney Center, Tokyo Womens Medical University
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