Heering, Peter and Braun, Norbert and Muellejans, Reinhard and Ivens, Katrin and Zaeuner, Ingeborg and Fuenfstueck, Reinhard and Keller, Frieder and Kraemer, Bernhard K. and Schollmeyer, Peter and Risler, Teut and Grabensee, Bernd (2004) Cyclosporine A and chlorambucil in the treatment of idiopathic focal segmental glomerulosclerosis. AMERICAN JOURNAL OF KIDNEY DISEASES, 43 (1). pp. 10-18. ISSN 0272-6386
Full text not available from this repository. (Request a copy)Abstract
Background. The therapy of nephrotic syndrome in focal segmental glomerulosclerosis (FSGS) is still a matter of controversy. Methods We performed a prospective randomized study of the treatment of nephrotic syndrome due to FSGS. We compared 2 specific treatment protocols to assess the effect of treatment on proteinuria and renal function. Fifty-seven patients were randomly assigned to 2 groups: group 1 (n = 34) received steroids and cyclosporine, and group 2 (n = 23) received steroids and chlorambucil for 6 months. When treatment was refractory to chlorambucil, the patients in this group were treated with cyclosporine. Creatinine, blood urea nitrogen, proteinuria, lipids, and arterial hypertension were monitored at regular intervals. Results: Patients showed a mean serum creatinine of 1.5 +/- 0.2 mg/dL (132.6 +/- 17.7 mumol/L) and proteinuria of 4.8 +/- 2.8 g/24 h with no differences between the groups. At the end of the chlorambucil therapy, patients in group 2 had creatinine levels of 1.8 +/- 0.6 mg/dL (159.1 +/- 53 mumol/L) and proteinuria levels of 3.4 +/- 1 g/24 h. All patients in this group were given cyclosporine. After 4 years the mean creatinine level in group 1 was 1.7 +/- 0.4 mg/dL (150.3 +/- 35.4 mumol/L) and the proteinuria level was 2.5 +/- 1 g/24 h. In group 2, the mean creatinine level was 1.9 +/- 0.6 mg/dL (168 53 mumol/L) (not significant [NS]) and the mean proteinuria level was 2.3 +/- 1.1 g/24 h (NS). Full remission occurred in 23% of the patients in group 1 (n = 8) and 17% of the patients in group 2 (n = 4; NS). Partial remission was observed in 38% of the patients in group 1 (n = 13) and 48% in group 2 (n = 11; NS). The number of patients who developed end-stage renal disease was comparable in both groups: 4 of 34 patients in group I after 2.5 +/- 0.8 years, and 5 of 23 patients in group 2 (NS). Conclusion: Additional treatment with chlorambucil was found to be ineffective in FSGS. Patients responded to treatment with steroids or cyclosporine, but additional treatment with chlorambucil did not improve the patient's outcome. Future studies must focus on the long-term prognosis of these patients.
| Item Type: | Article |
|---|---|
| Uncontrolled Keywords: | ADULT NEPHROTIC SYNDROME; MEMBRANOUS NEPHROPATHY; AUTOIMMUNE-DISEASES; RANDOMIZED-TRIAL; FOLLOW-UP; THERAPY; CHILDREN; GLOMERULONEPHRITIS; METHYLPREDNISOLONE; MULTICENTER; cyclosporine A (CsA); nephrotic syndrome; focal segmental glomerulosclerosis (FSGS) |
| Subjects: | 600 Technology > 610 Medical sciences Medicine |
| Divisions: | Medicine > Lehrstuhl für Innere Medizin II |
| Depositing User: | Dr. Gernot Deinzer |
| Date Deposited: | 02 Aug 2021 11:49 |
| Last Modified: | 02 Aug 2021 11:49 |
| URI: | https://pred.uni-regensburg.de/id/eprint/38098 |
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