Cattran Daniel C
Department of Medicine, Toronto General Hospital, University Health Network, Toronto, Ontario, Canada.
Semin Nephrol. 2003 Mar;23(2):234-41. doi: 10.1053/snep.2003.50022.
Cyclosporine a known powerful immunosuppressive medication and has been used in the treatment of focal segmental glomerulosclerosis (FSGS) for over a decade. Its precise mechanism of action in this disorder is still debated and is likely at more than one level related to the pathophysiology of the disease. Multiple studies have been performed but the numbers of randomized trials of this drug in this disease are very limited. However, both the best studies in children and adults indicate in the steroid-resistant patients that 50% to 70% will have a response in terms of a significant reduction in proteinuria. Provided the total dose is kept to 5 mg/kg or less and duration to less than 12 months, the drug is safe but careful monitoring is required to maintain the blood pressure at ideal levels and to avoid nephrotoxicity. Relapses are common, but rather than considering this a failure of therapy the drug should be reintroduced because in most cases it will reestablish control of the proteinuria. Although in the past cyclosporine has been considered a second-line agent in FSGS, emerging data would suggest in the high-risk patients related to corticosteroid toxicity it should be considered primary therapy.
