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- Title
Ocena czynności nerek u dzieci ze steroidozależnym zespołem nerczycowym leczonych cyklosporyną A i mykofenolanem mofetilu.
- Authors
KWINTA-RYBICKA, Joanna; ZACHWIEJA, Katarzyna; KOROHODA, Przemysław; WIERZCHOWSKA-SŁOWIACZEK, Ewa; WILKOSZ, Katarzyna; OGAREK, Iwona; DROŻDŻ, Dorota
- Abstract
Children with steroid-dependent nephrotic syndrome (SDNS) require many years administration of corticosteroids and long-term immunosuppressive therapy; this increases the risk of adverse reactions, including cyclosporine nephropathy. The aim of this study was to assess renal function in children with SDNS in long-term treatment with cyclosporine A and mycophenolate mofetil; the assessment was made with eGFR calculations based on several formulae that use creatinine and cystatine C concentrations: that of Schwartz of 2009 (S-2009) and the three-marker Schwartz formula of 2012 (S-3M). Material and methods: The study group (ZNS) included 38 children (14 females) in long-term treatment for idiopathic nephrotic syndrome. Follow-up time was an average of 8.21+/-2.13 years; disease duration was 12.7+/-3.5 years; cyclosporine A treatment duration was 9.1 +/-3.65 lat. The patients were divided into two groups: MMF+CsA, which included 22 children treated with cyclosporine A and mycophenolate mofetil, and CsA, which included 16 children treated with cyclosporine A and who did not require mycophenolate mofetil during follow-up. In all patients, eGFR was calculated with the S-2009 and S-3M formulae; relapses were counted and mean blood CsA was measured. The results for both groups were compared. Results: At beginning of follow-up, eGFR based on the S-3M formula was at an average of 104.9±28.9 and, based on the S-2009 formula, 150.8±55.4 ml/min/1.73 m2. At end of follow-up, eGFR was 109.9±14.9 and 115.6±23.4 ml/min/1.73 m2 respectively. Beginning and end eGFR showed no significant differences between the two groups irrespective of the formula, while a comparison of eGFR measured with S-2009 at beginning and end of follow-up within each group yielded a significant decrease from an average of 144.3 to 112.8 ml/min/1.73 m2 (p=0.047) in the MMF group and from 160.8 to 104.9 ml/ min/1.73 m2 (p=0.012) in the CsA group. Conclusions: In children with SDNS in long-term treatment with cyclosporine A, monitoring renal function with the S-2009 and S-3M formulae and modification of the regime (e.g. inclusion of mycophenolate mofetil) allows to limit adverse reactions and preserve renal function.
- Publication
Review of Medicine / Przeglad Lekarski, 2019, Vol 76, Issue 5, p247
- ISSN
0033-2240
- Publication type
Article