XX Congress of the Spanish Society of Nephrology

Abstract

Cyclosporine in glomerulonephritis. Preliminary data from 61 patients included in the Cooperative Study of the Spanish Society of Nephrology. Study Group of the Spanish Society of Nephrology. The preliminary results of the Cooperative Study of the Spanish Society of Nephrology about the treatment of glomerulonephritis with CyA are recorded. This is a retrospective multicenter study which included data from 17 hospitals; there were 40 adult patients (30 INS, 5 membranous GN, 3 membranoproliferative GN and 2 SLE) and 21 children (all of them with INS). The initial oral dose most frequently used in patients with INS was 5 mg/kg/day for adults and 4 mg/kg/day for pediatric patients, and this was then adjusted to obtain total blood levels of 250 to 500 ng/ml. The mean duration of treatment was 6 months, but 30% of patients received CyA during more prolonged period. The response of children with INS was well correlated to the initial steroid responsiveness, as all steroid responders reacted to CyA whereas only 25% of ateroid non-responders did so. In adults with INS, however, there was a correlation with the previous steroid responsiveness (steroid responders: 66% remission (R) + 16% partial response (PR) vs. steroid non-responderR + PR:0 + 55%, but also with the histopathological categories (minimal change disease55 + 22%; diffuse mesangial proliferation40 + 20%; focal and segmental glomerulosclerosis18 + 36%). The follow-up time was too short in most of patients to evaluate the long term effects of this therapy. Only 1 out of 5 membranous GN (20%) went into complete remission within the first month of treatment, with two other decreases of proteinuria but persistence of nephrotic syndrome. None of the patients with MPGN responded to CyA. Side effects related to CyA were usually mild. However, 25% of patients experienced impairment of renal function, usually mild, but in which, factors other than nephrotoxicity could not be excluded with available data. Controlled trials are needed in order to establish the cost benefit ratio of CyA in INS and other glomerulonephropathies