Cyclosporin A treatment of severe steroid resistant nephrotic syndrome in adults.

Ten adult patients with a severe nephrotic syndrome resistant to conventional immunosuppression were treated with cyclosporin A (CyA) for a mean period of 11 months. CyA was effective in all but two patients, as evaluated by 24-h urine protein excretion and clinical appearance. In general the best effect of CyA was seen in patients with minimal change disease and in those who had normal kidney function before CyA was initiated. CyA-induced nephrotoxicity was observed in four patients. There was no correlation with the duration of CyA therapy. Hypertension was accentuated and required multidrug treatment in five patients. This side-effect tended to be most pronounced among patients with reduced kidney function at onset of CyA therapy. In conclusion, CyA is effective in the treatment of severe steroid resistant adult nephrotic syndrome. For most patients in the present study, CyA reduced proteinuria by at least 70% to less than 3.5 g of protein per day in 8 of 10 patients; only two patients were unresponsive to CyA treatment.