Department of Nephrology, Hypertension and Endocrinology, Nihon University School of Medicine, 30-1 Oyaguchi-kamimachi, Itabashiku, Tokyo, 173-8610, Japan.
Int Urol Nephrol. 2013 Jun;45(3):803-8. doi: 10.1007/s11255-012-0264-3. Epub 2012 Sep 7.
Cyclosporine (CsA) is often prescribed to patients with glucocorticoid (GC)-dependent nephrotic syndrome. Although it is well known that long-term administration of GC causes osteoporosis, the effects of CsA on bone metabolism are not fully established. Therefore, we examined the effects of CsA on bone metabolism in patients with GC-dependent nephrotic syndrome in remission.
We followed 23 patients treated with prednisolone alone (GC alone group) and 17 patients treated with CsA in combination with prednisolone (GC + CsA group). Bone mineral density (BMD) was measured by dual-energy X-ray absorptiometry, and biochemical markers of bone metabolism were simultaneously measured in serum and urine samples.
BMD decreased significantly in the GC group from 752 to 623 mg/cm(2) but non-significantly in the GC + CsA group from 751 to 684 mg/cm(2). Although the cumulative dose of GC increased in both groups, there were no significant differences in biochemical markers at either the start or the end of the study. Vertebrate bone fracture and other side effects associated with CsA treatment did not occur in our study.
Our results indicate that CsA does not accelerate GC-induced osteoporosis in patients with nephrotic syndrome. We conclude that CsA is appropriate for the treatment of GC-dependent nephrotic syndrome, because it does not adversely affect bone metabolism and has favorable glomerular effects.
环孢素（CsA）常被用于治疗依赖糖皮质激素（GC）的肾病综合征患者。虽然长期使用 GC 会导致骨质疏松症已广为人知，但 CsA 对骨代谢的影响尚未完全确定。因此，我们研究了 CsA 对缓解期 GC 依赖型肾病综合征患者骨代谢的影响。
我们随访了单独使用泼尼松龙（GC 组）治疗的 23 例患者和联合使用 CsA 与泼尼松龙（GC+CsA 组）治疗的 17 例患者。通过双能 X 射线吸收法测量骨矿物质密度（BMD），并同时测量血清和尿液样本中的骨代谢生化标志物。
GC 组的 BMD 从 752 降至 623 mg/cm(2)，但 GC+CsA 组的 BMD 从 751 降至 684 mg/cm(2)，降幅无统计学意义。虽然两组的 GC 累积剂量均增加，但在研究开始和结束时，生化标志物均无显著差异。我们的研究中未发生与 CsA 治疗相关的脊椎骨骨折和其他副作用。
我们的结果表明，CsA 不会加速肾病综合征患者的 GC 诱导性骨质疏松症。我们得出结论，CsA 适用于治疗依赖 GC 的肾病综合征，因为它不会对骨代谢产生不利影响，并且对肾小球具有良好的作用。
