| Home | E-Submission | Sitemap | Contact Us |  
Journal of the Korean Society of Pediatric Nephrology 1999;3(2): 130-144.
소아 신증후군에서 Cyclosporine A에 의한 만성 조직학적 신독성의 발현빈도에 대한 연구
김지홍, 정현주, 최인준, 김병길
1연세대학교 의과대학 소아과학교실 및 신장질환연구소
2연세대학교 의과대학 병리학교실 및 신장질환연구소
3연세대학교 의과대학 병리학교실 및 신장질환연구소
4연세대학교 의과대학 소아과학교실 및 신장질환연구소
Incidence of Chronic Pathologic Nephrotoxicity of Cyclosporine A in Pediatric Nephrotic Syndrome
Ji-Hong Kim, Hyun-Ju Jeong, In-Jun Choi, Pyung-Kil Kim
1Departments of Pediatrics, The Institute of Kidney Disease, Yonsei University College of Medicine
2Departments of Patholgy and The Institute of Kidney Disease, Yonsei University College of Medicine
3Departments of Pathology and The Institute of Kidney Disease, Yonsei University College of Medicine
4Departments of Pediatrics, The Institute of Kidney Disease, Yonsei University College of Medicine
Share :  
ABSTRACT
Purpose : Long-term use of Cyclosporine(CsA) reduce renal blood flow by afferent arteriolar vasoconstriction and lead to chronic pathologic changes of CsA nephrotoxicity - 1) interstitial nephritis(IN); tubular atrophy (TA) and/or interstitial fibrosis(IF),2) arteriolopathy(AP). The Object of this study is to estimate the incidence of chronic pathologic CsA nephrotoxicity by duration of treatment and type of renal disease, relationship between histologic and clinical nephrotoxicity, and optimal duration of CsA therapy.
Methods : 102 children with steroid resistant or dependent nephrotic syndrome confirmed by renal biopsy and treated with CsA from 1986 to 1997 were enrolled in this study(58 MCNS, 10 FSGS, 10 MGN, 15 $Henoch-Sch""{o}nlein$ purpura nephritis with nephrotic syndrome (HSPN) and 9 IgA nephropathy with nephrotic syndrome(IgAN)). CsA was administered for 1yr, 1.5yr, 2yr in 24, 12, 22 MCNS patients and 2, 2, 6 FSGS patients respectively, 1yr, 2yr in MGN and 1yr in HSPN and IgAN. Sequential biopsies were done in all 102 patients after CsA treatment for evaluation of pathologic nephrotoxicity.
Results : Complete remission rate was 92.2% (100% in MCNS and MGN, 80% in FSGS, 86.6% in HSPN and 55.5% in IgAN). Incidence of relapse during 6months after CsA treatment was significantly decreased compaed with relapsing spisodes during 6months before CsA treatment in MCNS(P<0.0001) and FSGS(P<0.0001). According to pathologic changes, 71 patients(69.6%) showed no pathological change, 24 patients(23.5%) showed IN and 7 patients(6.8%) showed AP. IN was 16.6%, 33.3%, 27.2% in 1, 1.5, 2 year of CsA treatment group in MCNS. AP was 0%, 16.6%, 9% in 1, 1.5, 2 year of CsA treatment group in MCNS. 14 out of 58 MCNS(24.1%) showed IN and 4 out of 58 MCNS(6.8%) showed AP. Incidence of pathologic change was significantly lower in CsA therapy of <1yr than >1yr(P=0.03). There were no significant difference of incidence of pathologic change in original renal disease, age and sex.
Conclusion : Duration of CsA treatment was significant risk factor for nephrotoxicity and optimal duration seemed to be 1 year. Pathologic change due to nephrotoxicity did not correlate with deterioration of renal function and only detectable by renal biopsy.
Key words: Cyclosporine A | Nephrotoxicity | Childhood nephrotic syndrome
Editorial Office
124 Bukbyunjeung-ro, Kimpo, Jesewoong 2-103, Gyeonggi-do 10098, Republic of Korea
TEL : +82-31-987-5963   FAX : +82-31-987-5967   E-mail : chikd.editor@gmail.com or ckdeditor@kspn.org

Copyright© Korean Society of Pediatric Nephrology. All rights reserved.                powerd by m2community
About |  Browse Articles |  Current Issue |  For Authors and Reviewers