Sabry Alaa, El-Husseini Amr, El-Dahshan Khaled, Sobh Mohamed
Nephrology and Internal Medicine Department, Urology and Nephrology Center, University of Mansoura, Egypt.
Iran J Kidney Dis. 2009 Jul;3(3):127-35.
Cyclosporine A is used in the treatment of idiopathic nephrotic syndrome. We conducted this study to evaluate the effect of cyclosporine and its combination with ketoconazole in Egyptian nephrotic children with steroid-resistant and steroid-dependant minimal change.
Forty-eight children with minimal change lesions who received cyclosporine with or without ketoconazole were studied. Their mean age was 5.17 +/- 1.59 years, and they were 31 boys and 17 girls. The mean duration of the disease was 6.22 +/- 3.16 years. Thirty-one of the children were steroid dependent and 17 were steroid resistant. Cyclosporine treatment was commenced after remission was attained and adjusted to a target trough level of 100 ng/mL. The mean cyclosporine therapy at a dose of 2.07 +/- 0.91 mg/kg was administered for a mean of 25.75 +/- 1.95 months. Thirty-three patients received adjunctive ketoconazole therapy.
Thirty-eight patients (79.2%) responded well to cyclosporine. Steroid therapy could be discontinued in 43 patients (89.6%), but 9 experienced relapse. Ten patients (20.8%) were resistant to cyclosporine therapy. Fifteen patients received cyclosporine alone, while 33 received concomitant cyclosporine and ketoconazole. The response to cyclosporine was significantly better in those on ketoconazole. The economic effect of ketoconazole therapy was a reduction in the costs of cyclosporine treatment by 47.4% at 1 year of treatment.
Cyclosporine treatment in children with minimal change nephrotic syndrome is effective in preventing relapse and decreasing steroid toxicity. Its combination with low-dose ketoconazole is safe, reduces treatment costs, and improves the response to cyclosporine.
环孢素A用于治疗特发性肾病综合征。我们开展本研究以评估环孢素及其与酮康唑联合用药对埃及患有激素抵抗型和激素依赖型微小病变的肾病患儿的疗效。
对48例接受环孢素治疗（无论是否联用酮康唑）的微小病变患儿进行研究。他们的平均年龄为5.17±1.59岁，其中男孩31例，女孩17例。疾病的平均病程为6.22±3.16年。31例患儿为激素依赖型，17例为激素抵抗型。在病情缓解后开始环孢素治疗，并将目标谷浓度调整为100 ng/mL。环孢素的平均治疗剂量为2.07±0.91 mg/kg，平均给药时间为25.75±1.95个月。33例患者接受了辅助酮康唑治疗。
38例患者（79.2%）对环孢素反应良好。43例患者（89.6%）可以停用激素治疗，但9例出现复发。10例患者（20.8%）对环孢素治疗耐药。15例患者仅接受环孢素治疗，33例患者同时接受环孢素和酮康唑治疗。联用酮康唑的患者对环孢素的反应明显更好。酮康唑治疗的经济效果是在治疗1年时将环孢素治疗成本降低了47.4%。
环孢素治疗微小病变型肾病综合征患儿可有效预防复发并降低激素毒性。其与低剂量酮康唑联合使用安全，可降低治疗成本，并改善对环孢素的反应。
