The place of cyclosporin in the management of primary nephrotic syndrome

被引:18
作者
Ponticelli, C [1 ]
Passerini, P [1 ]
机构
[1] Osped Maggiore, IRCCS, Div Nefrol & Dialisi, I-20122 Milan, Italy
关键词
D O I
10.2165/00063030-199912050-00002
中图分类号
R73 [肿瘤学];
学科分类号
100214 ;
摘要
The 3 main causes of primary nephrotic syndrome are minima change nephropathy, focal segmental glomerulosclerosis and membranous nephropathy. Corticosteroids result in remission of proteinuria in most patients with minimal change nephropathy. Many patients, however, develop corticosteroid dependency. A course of cytotoxic drugs can also achieve remission but these agents cannot be administered for prolonged periods or in repeated cycles because their toxicity is cumulative. Review of the available literature indicates that cyclosporin may maintain remission of nephrotic syndrome in about 80% of patients with corticosteroid-sensitive disease, indicating an important role for this drug in patients with frequent relapses or corticosteroid dependency. Although cyclosporin is less effective in patients with focal segmental glomerulosclerosis, which is often corticosteroid-resistant, a number of studies indicate that it may be successful both in the few steroid-sensitive patients with frequent relapses and in some corticosteroid-resistant patients. In patients with membranous nephropathy, a 6-month course of corticosteroids and cytotoxic agents may favour remission of nephrotic syndrome and protect renal function. Several studies have shown that cyclosporin can improve proteinuria, and there is a tentative suggestion that it might also protect against renal function deterioration. The risk of nephrotoxicity can be minimised if cyclosporin is used at the correct doses and if renal function is carefully monitored during treatment. In summary, cyclosporin can be considered a useful tool for treating patients with nephrotic syndrome associated with primary glomerulonephritis.
引用
收藏
页码:327 / 341
页数:15
相关论文
共 116 条
[81]   COMPARISON OF CYCLOSPORINE AND CHLORAMBUCIL IN THE TREATMENT OF STEROID-DEPENDENT IDIOPATHIC NEPHROTIC SYNDROME - A MULTICENTER RANDOMIZED CONTROLLED TRIAL [J].
NIAUDET, P .
PEDIATRIC NEPHROLOGY, 1992, 6 (01) :1-3
[82]   ADULT ONSET MINIMAL CHANGE NEPHROTIC SYNDROME - A LONG-TERM FOLLOW-UP [J].
NOLASCO, F ;
CAMERON, JS ;
HEYWOOD, EF ;
HICKS, J ;
OGG, C ;
WILLIAMS, DG .
KIDNEY INTERNATIONAL, 1986, 29 (06) :1215-1223
[83]  
PASSERINI P, 1989, NEPHROL DIAL TRANSPL, V4, P525
[84]   EVIDENCE SUGGESTING UNDER-TREATMENT IN ADULTS WITH IDIOPATHIC FOCAL SEGMENTAL GLOMERULOSCLEROSIS - REGIONAL GLOMERULONEPHRITIS REGISTRY STUDY [J].
PEI, Y ;
CATTRAN, D ;
DELMORE, T ;
KATZ, A ;
LANG, A ;
RANCE, P .
AMERICAN JOURNAL OF MEDICINE, 1987, 82 (05) :938-944
[85]   FUNCTIONAL-SIGNIFICANCE OF EXAGGERATED RENAL THROMBOXANE A2 SYNTHESIS INDUCED BY CYCLOSPORINE-A [J].
PERICO, N ;
BENIGNI, A ;
ZOJA, C ;
DELAINI, F ;
REMUZZI, G .
AMERICAN JOURNAL OF PHYSIOLOGY, 1986, 251 (04) :F581-F587
[86]  
PONTICELLI C, 1993, NEPHROL DIAL TRANSPL, V8, P1326
[87]   METHYLPREDNISOLONE PLUS CHLORAMBUCIL AS COMPARED WITH METHYLPREDNISOLONE ALONE FOR THE TREATMENT OF IDIOPATHIC MEMBRANOUS NEPHROPATHY [J].
PONTICELLI, C ;
ZUCCHELLI, P ;
PASSERINI, P ;
CESANA, B .
NEW ENGLAND JOURNAL OF MEDICINE, 1992, 327 (09) :599-603
[88]   A 10-YEAR FOLLOW-UP OF A RANDOMIZED STUDY WITH METHYLPREDNISOLONE AND CHLORAMBUCIL IN MEMBRANOUS NEPHROPATHY [J].
PONTICELLI, C ;
ZUCCHELLI, P ;
PASSERINI, P ;
CESANA, B ;
LOCATELLI, F ;
PASQUALI, S ;
SASDELLI, M ;
REDAELLI, B ;
GRASSI, C ;
POZZI, C ;
BIZZARRI, D ;
BANFI, G .
KIDNEY INTERNATIONAL, 1995, 48 (05) :1600-1604
[89]   TREATMENT OF THE NEPHROTIC SYNDROME-ASSOCIATED WITH PRIMARY GLOMERULONEPHRITIS [J].
PONTICELLI, C ;
PASSERINI, P .
KIDNEY INTERNATIONAL, 1994, 46 (03) :595-604
[90]   CONTROLLED TRIAL OF METHYLPREDNISOLONE AND CHLORAMBUCIL IN IDIOPATHIC MEMBRANOUS NEPHROPATHY [J].
PONTICELLI, C ;
ZUCCHELLI, P ;
IMBASCIATI, E ;
CAGNOLI, L ;
POZZI, C ;
PASSERINI, P ;
GRASSI, C ;
LIMIDO, D ;
PASQUALI, S ;
VOLPINI, T ;
SASDELLI, M ;
LOCATELLI, F .
NEW ENGLAND JOURNAL OF MEDICINE, 1984, 310 (15) :946-950