Remission patterns and renal function status from the use of cyclosporine in children with idiopathic steroid-resistant Nephrotic Syndrome at a Nigerian Tertiary Health-Facility

Abstract

Background: Although cyclosporine A (CsA) is now the recommended first-line treatment for idiopathic steroid-resistant nephrotic syndrome (iSRNS), adverse effects on renal function have been reported.

Objective:  To determine the rate of remission, renal function status, and side effects from the use of CsA in children with iSRNS seen at the Pediatric Nephrology Firm of the University of Nigeria Teaching Hospital, Enugu.

Method: A retrospective study of twelve children with idiopathic nephrotic syndrome, who failed to achieve remission despite treatment with an appropriate dose of oral prednisolone at 2mg/kg/day for 8weeks (iSRNS) and who could afford and sustain CsA therapy for 18 months.

Results: Seven (58.3%) patients achieved complete remission within the first six months of CsA therapy. The only patient who failed to achieve remission developed severe hypertension and impaired renal function by the second month, necessitating immediate withdrawal of the drug. Another patient who achieved remission on the 3rd month of treatment received the drug for 26 months and developed lesions suggestive of Kaposi sarcoma.

Conclusion: CsA is useful in the treatment of iSRNS. However, there should be a periodic assessment of renal function as the duration of therapy should not exceed 18 months because of its nephrotoxicity.

Keywords: idiopathic nephrotic syndrome, steroid resistance, calcineurin inhibitor, remission, nephrotoxicity