We treated 16 steroid dependent, steroid resistant and frequently relapsing minimal change nephrotic syndrome, 2 focal segmental glomerulosclerosis and 2 other glomerulonephritis patients with oral cyclosporine for 8 months. Cyclosporine was
started at
an initial dose of 5mg/kg/day in t3wo divvided doses along with 10mg of prednisolone. Of these 20 patients, 2 withdrew early from study for reasons other than complications of cyclosporine treatment. The efficacy of cyclosporine was evaluated in
remaining 18 patients. Cyclosporine induced a complete remission in 14 patients, partiald remission in two, and failed in 4 patients. Complete remission occurred in 5±1.2 weeks (range 2~16 weeks) of treatment. There was no correlation between
the
previous response to steroid and the efficacy of cyclosporine. Cyclosporine was much effective in minimal change nephrotic syndrome. We obtained complete remission in 14 out of 16, namly, 87% of minimal change nephrotic syndrome and failed to
induce
remission in only 2 patients. On the other hand, only one patient with focal segmental glomeruloxclerosis entered partial remission and the other one failed 24 hour urinary protein excretion pmoptly improved with cyclosporine treatment. It fell
from
11.76g to 5.02g within 2 weeks of treatment and to nadir, 0.44g at 5 months, and slightly rose thercafter up to the endof the study. Tolerence to the treatment was excellent. Minor side effect, such as gum hypertrophy, hypertrichosis and
hyperbilirubinemia were reported in small number of patients, but these were not serious enough to interrupt the study. Blood pressure and the serum creatinine level Twelve out of 16 patients who were in remission with cyclosporine treatment
relapased
after withdrwal of cyclosprine. The relapse rate was 75%. Relapse occurred in 4.5±0.7 weeks (range 1~14 weeks) after stop ping cyclosporine.
In conclusion, cyclosporine is a good alternative to steroids in the treatment of minimal change nephrotic syndrome, particularly in steroid dependetnt and frequent relapsers who are at risk of developing steroid toxicity. Cyclosporine needs to
be
administered for a long periods of time in these patients because of the high incidence of relapses on withdrawals of cyclosporine. Consequently, close monitoring of renal function is required to prevent renal functional impairement.
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