High Response and Relapse Rate in Cyclosporine-Treated Minimal Change Disease and Focal Segmental Glomerulosclerosis in Taiwanese Patients

Background: Cyclosporine (CsA) is used in steroid-resistant and dependent minimal change disease (MCD) and focal segmental glomerulosclerosis (FSGS). The clinical experience is limited in Taiwanese patients who received a low dose of CsA combined with corticosteroid. Materials and Methods: We conducted a retrospective case series study of biopsy-proven MCD (15 patients) and FSGS (7 patients) with CsA treatment between 2004 and 2007. CsA therapy was used in steroid-resistant (SR) or steroid-dependent (SD) patients. The treatment protocol consisted of CsA 3 mg/Kg/day and prednisolone 10 mg/day. The clinical features, outcome, and adverse effects were assessed in detail. Results: Twenty-two patients received CsA therapy during the study period. Seventeen patients (77.3%) were steroid dependent (SD) and five patients (22.7%) were steroid-resistant (SR). In the MCD group, CsA therapy induced remission in eleven patients (73%). The mean duration for CsA-responsiveness was 5.0±1.8 weeks. Out of seven patients who withdrew from CsA, six patients (85.7%) relapsed wit/tin 20.2±4.1 weeks. The experience in the FSGS group was similar. The mean time to ac/sieve CsA-responsiveness was 4.6±2.7 weeks. Four of four patients (100%) relapsed within 18.6±6.2 weeks. Previous ”steroid responsiveness” was the most powerful predictor of a favorable CsA response (P＜0.05). Hypertrichosis, gum hypertrophy, hypertension, and transient hyperkalemia occurred in 50%, 27.2%, 9.1%, and 4.5% of patients, respectively. No patient developed renal dysfunction in the observation period. Conclusion: A low dose of CsA combined with corticosteroid is effective and safe for treatment of SD/SR patients with MCD and FSGS in Taiwan. However the relapse rate remains high after withdrawal of CsA.