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Renal function and proteinuria after successful immunosuppressive therapies in patients with FSGS. Clin J Am Soc Nephrol 2013 Feb;8(2):211-8

Date

11/13/2012

Pubmed ID

23143503

Pubmed Central ID

PMC3562866

DOI

10.2215/CJN.08330812

Scopus ID

2-s2.0-84875038359   18 Citations

Abstract

BACKGROUND AND OBJECTIVES: In the FSGS Clinical Trial, 22 cyclosporine-treated and 20 mycophenolate/dexamethasone-treated patients experienced a complete or partial remission after 26 weeks, completed 52 weeks of treatment, and were studied through 78 weeks. Herein, changes in the urine protein/creatinine ratio (UP/C) and estimated GFR (eGFR) throughout the entire study period are defined.

DESIGN, SETTING, PARTICIPANTS, AND MEASUREMENTS: The FSGS Clinical Trial, which was conducted from November 2004 to January 2010, enrolled patients aged 2-40 years, with eGFR ≥40 ml/min per 1.73 m(2) and UP/C >1 mg/mg after ≥4 weeks of corticosteroid therapy. Both groups received lisinopril or losartan throughout the study. UP/C and eGFR were measured at 0, 26, 52, and 78 weeks.

RESULTS: The median UP/C in the cyclosporine- and mycophenolate/dexamethasone-responsive patients fell by 89.8% and 82.7% at 52 weeks; the fall was largely sustained at 78 weeks (74.7% and 80.3%, respectively). The mean eGFR fell by 19.4% in the cyclosporine group and rose by 7.0% in the mycophenolate mofetil/dexamethasone group at 52 weeks, but subsequently rose by 16.4% and fell by 2.6%, respectively, in the two groups from 52 to 78 weeks.

CONCLUSIONS: In this subset of responding FSGS patients, the improvement in UP/C after cyclosporine or mycophenolate/dexamethasone treatment was largely sustained for 6 months after therapy. Reduction in eGFR in the cyclosporine group was improved 6 months after cyclosporine was stopped although the levels were lower than baseline in seven patients who entered the study with decreased eGFR.

Author List

Hogg RJ, Friedman A, Greene T, Radeva M, Budisavljevic MN, Gassman J, Gipson DS, Jefferson JA, John EG, Kaskel FJ, Moudgil A, Moxey-Mims M, Ortiz LA, Schelling JR, Schnaper W, Srivastava T, Trachtman H, Vehaskari VM, Wong C, Woronieki RP, Van Why SK, Zolotnitskaya A

Author

Scott K. Van Why MD Professor in the Pediatrics department at Medical College of Wisconsin




MESH terms used to index this publication - Major topics in bold

Adolescent
Adult
Child
Child, Preschool
Cyclosporine
Dexamethasone
Drug Therapy, Combination
Female
Glomerulosclerosis, Focal Segmental
Humans
Immunosuppressive Agents
Kidney Function Tests
Male
Mycophenolic Acid
Prospective Studies
Proteinuria
Young Adult