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Predictive factors for ciclosporin-associated nephrotoxicity in children with minimal change nephrotic syndrome
  1. Ji Hong Kim1,
  2. Se Jin Park1,
  3. So Jin Yoon1,
  4. Beom Jin Lim2,
  5. Hyeon Joo Jeong2,
  6. Jae Seung Lee1,
  7. Pyung Kil Kim1,
  8. Jae Il Shin1
  1. 1The Institute of Kidney Disease, Department of Pediatrics, Yonsei University College of Medicine, Severance Children's Hospital, Seoul, Korea
  2. 2The Institute of Kidney Disease, Department of Pathology, Yonsei University College of Medicine, Seoul, Korea
  1. Correspondence to Professor Jae Il Shin, Department of Pediatrics, Yonsei University College of Medicine, Sungsan-Ro 250, Seodaemun-Ku, C.P.O. Box 8044, Seoul 120-752, Korea; shinji{at}yuhs.ac

Abstract

Aims To identify the predictive factors for ciclosporin A (CyA)-associated nephrotoxicity (CAN) in children with minimal change nephrotic syndrome (MCNS).

Methods The clinical and laboratory findings of 58 children (median age 3.2 years, range 1.1–13.1 years, male:female 48:10) with MCNS who were treated with CyA from 1992 to 2002 were analysed retrospectively. Forty-eight (83%) of them were steroid dependent and 10 (17%) were steroid resistant. The starting dose of CyA was 5 mg/kg per day, and the desired drug level was kept at 100–200 ng/ml. Serial renal biopsies were performed before and after CyA therapy.

Results Twenty-two patients (38%) had CAN (group I) and 36 (62%) did not (group II). There were no differences in the age at onset, sex, initial response to steroids, duration of CyA therapy and relapse rates. However, the median CyA trough levels were significantly higher in group I than in group II (218.0±15.2 vs 171.8±6.7 ng/ml, p=0.01). Changes in creatinine clearance were more decreased in group I than in group II (−39.4±8.2 vs 2.7±4.3 ml/min per 1.73 m2, p<0.0001). Multiple logistic regression analysis also revealed the median CyA trough level was an independent risk factor for the development of CAN (OR 1.025, 95% CI 1.007 to 1.044, p=0.007).

Conclusions The median CyA trough level was an independent and significant risk factor for the development of CAN in children with MCNS receiving moderate-dose CyA.

  • Children
  • ciclosporin A
  • colorectal cancer
  • cytokines
  • gall bladder
  • glomerulonephritis
  • histopathology
  • immunohistochemistry
  • kidney
  • minimal change nephrotic syndrome
  • nephrology
  • nephrotoxicity
  • oncogenes
  • paediatric pathology
  • pancreas
  • P53
  • toxin
  • vasculitis

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Footnotes

  • Competing interests None.

  • Ethics approval This study was approved by the institutional review board and the research ethics committee of Yonsei Severance Hospital.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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