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Predictive factors for ciclosporin-associated nephrotoxicity in children with minimal change nephrotic syndrome

Authors
 Ji Hong Kim  ;  Se Jin Park  ;  So Jin Yoon  ;  Beom Jin Lim  ;  Hyeon Joo Jeong  ;  Jae Seung Lee  ;  Pyung Kil Kim  ;  Jae Il Shin 
Citation
 JOURNAL OF CLINICAL PATHOLOGY, Vol.64(6) : 516-519, 2011 
Journal Title
 JOURNAL OF CLINICAL PATHOLOGY 
ISSN
 0021-9746 
Issue Date
2011
MeSH
Adolescent ; Child ; Child, Preschool ; Cyclosporine/adverse effects* ; Cyclosporine/blood ; Female ; Humans ; Immunosuppressive Agents/adverse effects* ; Immunosuppressive Agents/blood ; Infant ; Kidney Diseases/blood ; Kidney Diseases/chemically induced* ; Male ; Nephrosis, Lipoid/drug therapy* ; Risk Factors
Abstract
AIMS: To identify the predictive factors for ciclosporin A (CyA)-associated nephrotoxicity (CAN) in children with minimal change nephrotic syndrome (MCNS). METHODS: The clinical and laboratory findings of 58 children (median age 3.2 years, range 1.1-13.1 years, male:female 48:10) with MCNS who were treated with CyA from 1992 to 2002 were analysed retrospectively. Forty-eight (83%) of them were steroid dependent and 10 (17%) were steroid resistant. The starting dose of CyA was 5mg/kg per day, and the desired drug level was kept at 100-200 ng/ml. Serial renal biopsies were performed before and after CyA therapy. RESULTS: Twenty-two patients (38%) had CAN (group I) and 36 (62%) did not (group II). There were no differences in the age at onset, sex, initial response to steroids, duration of CyA therapy and relapse rates. However, the median CyA trough levels were significantly higher in group I than in group II (218.0±15.2 vs 171.8±6.7 ng/ml, p=0.01). Changes in creatinine clearance were more decreased in group I than in group II (-39.4±8.2 vs 2.7±4.3 ml/min per 1.73m(2), p<0.0001). Multiple logistic regression analysis also revealed the median CyA trough level was an independent risk factor for the development of CAN (OR 1.025, 95% CI 1.007 to 1.044, p=0.007). CONCLUSIONS: The median CyA trough level was an independent and significant risk factor for the development of CAN in children with MCNS receiving moderate-dose CyA.
Full Text
http://jcp.bmj.com/content/64/6/516
DOI
10.1136/jclinpath-2011-200005
Appears in Collections:
1. College of Medicine (의과대학) > Dept. of Pediatrics (소아청소년과학교실) > 1. Journal Papers
1. College of Medicine (의과대학) > Dept. of Pathology (병리학교실) > 1. Journal Papers
Yonsei Authors
Kim, Pyung Kil(김병길)
Kim, Ji Hong(김지홍) ORCID logo https://orcid.org/0000-0001-5352-5423
Park, Se Jin(박세진)
Shin, Jae Il(신재일) ORCID logo https://orcid.org/0000-0003-2326-1820
Lee, Jae Seung(이재승)
Lim, Beom Jin(임범진) ORCID logo https://orcid.org/0000-0003-2856-0133
Jeong, Hyeon Joo(정현주) ORCID logo https://orcid.org/0000-0002-9695-1227
URI
https://ir.ymlib.yonsei.ac.kr/handle/22282913/93789
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