Ciclosporin withdrawal
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Ciclosporin withdrawal Recurrence of glomerulosclerosis: case report An 18-year-old girl, who was receiving ciclosporin for immunosuppression, developed recurrence of focal segmental glomerulosclerosis after ciclosporin was discontinued. The girl, who had two mutations in the NPHS2 gene, had a history of nephrotic syndrome and had received a renal transplant 11 years previously. She was receiving ciclosporin at a mean dose of 4.1 mg/kg/day to achieve a mean trough level of 124 ng/mL [duration of treatment not stated]. Ciclosporin was discontinued because of nephrotoxicity, and she began receiving sirolimus. After 4 months, her glomerular filtration rate decreased to 50 mL/min per 1.73m2 (90 following transplantation). She developed pronounced proteinuria (10.7 g/m2/day) and hypoalbuminaemia, indicating recurrence of nephrotic syndrome. A kidney allograft biopsy revealed segmental glomerular sclerosis in one of nine glomeruli. Sirolimus was discontinued. The girl began receiving ciclosporin again, at a mean dose of 3.4 mg/kg/day. Subsequently, her proteinuria decreased to 1.3 g/m2/day and her glomerular filtration rate increased to 67 mL/min per 1.73m2. Author comment: "The pathophysiology of [focal segmental glomerulosclerosis] recurrence in our patient is still unclear to date. One possible mechanism at work may be that increasing proteinuria as a sign of recurrent [focal segmental glomerulosclerosis] is a reflection of [ciclosporin] withdrawal." H¨ocker B, et al. Recurrence of proteinuria 10 years post-transplant in NPHS2-associated focal segmental glomerulosclerosis after conversion from cyclosporin A to sirolimus. Pediatric Nephrology 21: 1476-1479, No. 10, Oct 2006 801049071 - Germany
0114-9954/10/1125-0001/$14.95 Adis © 2010 Springer International Publishing AG. All rights reserved
Reactions 28 Oct 2006 No. 1125
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