PMID- 23580804
OWN - NLM
STAT- PubMed-not-MEDLINE
DCOM- 20130415
LR  - 20211021
IS  - 0971-4065 (Print)
IS  - 1998-3662 (Electronic)
IS  - 0971-4065 (Linking)
VI  - 23
IP  - 1
DP  - 2013 Jan
TI  - Calcineurin inhibitor induced nephrotoxicity in steroid resistant nephrotic 
      syndrome.
PG  - 41-6
LID - 10.4103/0971-4065.107197 [doi]
AB  - Prolonged therapy with calcineurin inhibitors (CNI) is effective in patients with 
      difficult nephrotic syndrome. However, information on prevalence and risk factors 
      for nephrotoxicity in children with steroid-resistant nephrotic syndrome is 
      limited. This retrospective observational study was conducted on 40 patients with 
      steroid-resistant nephrotic syndrome treated with cyclosporine (CyA) (n = 28) or 
      tacrolimus (n = 12) for more than 2 years. Nephrotoxicity was defined by the 
      presence of striped fibrosis involving >/=10% of the interstitium or nodular 
      hyalinosis in more than one arteriole. Ten additional parameters were graded 
      semi-quantitatively. Continuous data are presented as median and interquartile 
      range (IQR). The median (IQR) age at onset of nephrotic syndrome and CNI therapy 
      were 30 (21-45) and 49.5 (40-102.5) months. A second renal biopsy, following 30 
      (26-35) months of CNI therapy, showed histological toxicity in 10 (25%) patients. 
      Toxicity was seen in 7 and 3 patients receiving CyA and tacrolimus, respectively, 
      and 5 patients each with minimal change and focal segmental glomerulosclerosis. 
      Therapy with CNI was associated with significant increases in scores for global 
      glomerulosclerosis, tubular atrophy, interstitial fibrosis, nonnodular arteriolar 
      hyalinosis (P < -0.001 for all), arteriolar smooth-muscle vacuolization (P = 
      -0.02), juxtaglomerular hyperplasia (P = -0.002), and tubular microcalcinosis (P 
      = -0.06). Risk factors for nephrotoxicity were initial resistance (OR 9; 95% CI 
      1.0-80.1; P = -0.049); dose of CyA (OR 9.2; 95% CI 1.1-74.6; P = -0.037); 
      duration of heavy proteinuria (OR 1.2; 95% CI 1.0-1.4; P = -0.023); and 
      hypertension during therapy (OR 6; 95% CI 1.3-28.3; P = -0.023). Following 
      prolonged CNI therapy, one in four biopsies show features of toxicity. Prolonged 
      duration of heavy proteinuria, hypertension, initial steroid resistance and high 
      CyA dose predict the occurrence of nephrotoxicity.
FAU - Sinha, A
AU  - Sinha A
AD  - Department of Pediatrics, Division of Nephrology, All India Institute of Medical 
      Sciences, New Delhi, India.
FAU - Sharma, A
AU  - Sharma A
FAU - Mehta, A
AU  - Mehta A
FAU - Gupta, R
AU  - Gupta R
FAU - Gulati, A
AU  - Gulati A
FAU - Hari, P
AU  - Hari P
FAU - Dinda, A K
AU  - Dinda AK
FAU - Bagga, A
AU  - Bagga A
LA  - eng
PT  - Journal Article
PL  - India
TA  - Indian J Nephrol
JT  - Indian journal of nephrology
JID - 8914356
PMC - PMC3621237
OTO - NOTNLM
OT  - Cyclosporine
OT  - focal segmental glomerulosclerosis
OT  - tacrolimus
COIS- Conflict of Interest: None declared.
EDAT- 2013/04/13 06:00
MHDA- 2013/04/13 06:01
PMCR- 2013/01/01
CRDT- 2013/04/13 06:00
PHST- 2013/04/13 06:00 [entrez]
PHST- 2013/04/13 06:00 [pubmed]
PHST- 2013/04/13 06:01 [medline]
PHST- 2013/01/01 00:00 [pmc-release]
AID - IJN-23-41 [pii]
AID - 10.4103/0971-4065.107197 [doi]
PST - ppublish
SO  - Indian J Nephrol. 2013 Jan;23(1):41-6. doi: 10.4103/0971-4065.107197.