Woo K T, Chew S T, Vathsala A, Chiang G S
Department of Renal Medicine, Singapore General Hospital, 1 Hospital Drive, Singapore 169608.
Ann Acad Med Singap. 2001 Jul;30(4):430-5.
Many centres still use steroids to induce remission in patients with minimal change nephrotic syndrome (MCNS) and failing that to give a course of cyclophosphamide, though some centres are already using cyclosporine A (CsA) as an alternative. We report the benefits of CsA therapy in 3 adults with difficult to treat MCNS in whom low dose CsA therapy proved to be efficacious.
The first patient had her 1st relapse after 8 years and thereafter had 2 more relapses, within 3 months of each other, in spite of therapy with cyclophosphamide. With CsA therapy, at a dose of 3.5 mg/kg body weight (BW)/day, she achieved lasting remission of 22 months as of September 1999 and is still in remission. The second patient had his relapses of nephrotic syndrome over a period of 10 years when treated with prednisolone and cyclophosphamide. On the 13th relapse, he achieved a remission lasting 21 months after a 3 month course of CsA at a dose of 4 mg/kg BW/day. With the 14th relapse, he took half the dose of CsA prescribed [only the morning dose of neoral CsA (2 mg/kg BW/day)] and still achieved a remission and has been in remission since. The third patient was a young woman, married for 2 years without children. She could not tolerate prednisolone because of erosive gastritis and she responded to a pulse dose of intravenous cyclophosphamide for her 1st episode of nephrotic syndrome with complete remission. However, when she relapsed 5 months later she did not respond to a similar dose of i.v. cyclophosphamide and was therefore treated with CsA (4 mg/kg BW/day) which induced a prompt remission 1 month after commencement of therapy and she is still in remission. The trough CsA levels for the 3 patients (range 41 to 107 ng/mL) and the calculated average CsA levels were lower than that used for post renal transplant immunosuppression. The trough CsA levels were, however, similar to that used in patients with MCNS from other series, though achieved at lower CsA doses.
Our study shows that low dose CsA is a useful agent for induction of remission of MCNS and maintenance of lasting remission. A low dose CsA regimen will make CsA more affordable.
许多中心仍使用类固醇诱导微小病变肾病（MCNS）患者缓解，若无效则给予环磷酰胺疗程，尽管一些中心已将环孢素A（CsA）作为替代药物。我们报告了3例难治性MCNS成年患者接受CsA治疗的益处，低剂量CsA治疗在这些患者中被证明是有效的。
首例患者在8年后首次复发，此后尽管接受环磷酰胺治疗，仍在3个月内又复发了2次。接受CsA治疗，剂量为3.5毫克/千克体重（BW）/天，截至1999年9月，她实现了22个月的持续缓解，目前仍处于缓解状态。第二例患者在接受泼尼松龙和环磷酰胺治疗的10年期间肾病综合征多次复发。在第13次复发时，他在接受了3个月的CsA疗程（剂量为4毫克/千克BW/天）后实现了持续21个月的缓解。第14次复发时，他服用了规定剂量一半的CsA（仅早晨服用新山地明CsA剂量，2毫克/千克BW/天），仍实现了缓解，且此后一直处于缓解状态。第三例患者是一名年轻女性，结婚2年未育。由于糜烂性胃炎，她无法耐受泼尼松龙，首次肾病综合征发作时，静脉注射环磷酰胺冲击剂量使她完全缓解。然而，5个月后复发时，她对类似剂量的静脉注射环磷酰胺无反应，因此接受CsA治疗（4毫克/千克BW/天），治疗开始1个月后迅速缓解，目前仍处于缓解状态。3例患者的CsA谷浓度（范围为41至107纳克/毫升）及计算得出的平均CsA浓度低于肾移植后免疫抑制所用浓度。然而，CsA谷浓度与其他系列MCNS患者所用浓度相似，尽管是在较低的CsA剂量下达到的。
我们的研究表明，低剂量CsA是诱导MCNS缓解和维持持续缓解的有效药物。低剂量CsA方案将使CsA更具可承受性。
