<abstract xmlns="http://www.w3.org/1999/xhtml"><bold>Background.</bold> Few data with adequate evidence exists as regards the effect of Cyclosporine (CsA) and mycophenolate mofetil (MMF) on pathological prognostic parameters in patients with steroid resistant focal segmental glomerulosclerosis (FSGS). The purpose of the present study is to compare the effect of cyclosporin and mycophenolate mofetil in addition to steroids on functional and histopathologic renal parameters in patients with steroid resistant FSGS one year after treatment.<bold>Material and methods.</bold> Thirty-seven adults with primary FSGS patients resistant to steroid therapy consecutively randomized to treatment with either MMF or cyclosporine. Low dose prednisolone added to both groups. Glomerular filtration rate (GFR) and blood pressure (BP) were determined at all examinations and a second renal biopsy was taken 12 months after treatment with either of cyclosporin and mycophenolate mofetil.<bold>Results.</bold> GFR significantly increased in MMF group p &lt; 0.01 after 6 months and unchanged after 12 months. On the other hand, GFR significantly decrease in CsA group p &lt; 0.001 after 6 months and reduced more after 12 months p &lt; 0.001 compared to base line levels. There was a significant difference of GFR between the 2 groups at 6 months p &lt; 0.001. The extent of proteinuria decreased significantly in CsA group after 12 months p &lt; 0.001. The extent of arteriolar hyalinosis increased significantly in CsA group (0.78 to 1.81 score, p &lt; 0.001) but was unchanged in MMF group (0.93 to 0.96 score), whereas interstitial fibrosis increased to same level in both groups (grade 3).<bold>Conclusion.</bold> Conversion to MMF in those patients may be superior to CsA as regards GFR after 12 months after treatment in spite of the presence of greater level of protein excretion. The increased arteriolar hyalinosis during CsA treatment most likely results in higher BP compared to MMF treatment in patients with FSGS resistant to steroids.</abstract>

Background. Few data with adequate evidence exists as regards the effect of Cyclosporine (CsA) and mycophenolate mofetil (MMF) on pathological prognostic parameters in patients with steroid resistant focal segmental glomerulosclerosis (FSGS). The purpose of the present study is to compare the effect of cyclosporin and mycophenolate mofetil in addition to steroids on functional and histopathologic renal parameters in patients with steroid resistant FSGS one year after treatment.Material and methods. Thirty-seven adults with primary FSGS patients resistant to steroid therapy consecutively randomized to treatment with either MMF or cyclosporine. Low dose prednisolone added to both groups. Glomerular filtration rate (GFR) and blood pressure (BP) were determined at all examinations and a second renal biopsy was taken 12 months after treatment with either of cyclosporin and mycophenolate mofetil.Results. GFR significantly increased in MMF group p < 0.01 after 6 months and unchanged after 12 months. On the other hand, GFR significantly decrease in CsA group p < 0.001 after 6 months and reduced more after 12 months p < 0.001 compared to base line levels. There was a significant difference of GFR between the 2 groups at 6 months p < 0.001. The extent of proteinuria decreased significantly in CsA group after 12 months p < 0.001. The extent of arteriolar hyalinosis increased significantly in CsA group (0.78 to 1.81 score, p < 0.001) but was unchanged in MMF group (0.93 to 0.96 score), whereas interstitial fibrosis increased to same level in both groups (grade 3).Conclusion. Conversion to MMF in those patients may be superior to CsA as regards GFR after 12 months after treatment in spite of the presence of greater level of protein excretion. The increased arteriolar hyalinosis during CsA treatment most likely results in higher BP compared to MMF treatment in patients with FSGS resistant to steroids.

Steroid resistant focal segmental glomerulosclerosis: effect of arterial hyalinosis on outcome: single center study

Department of Internal Medicine, Faculty of Medicine

Romanian Journal of Internal Medicine

This work is licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.

Background. Few data with adequate evidence exists as regards the effect of Cyclosporine (CsA) and mycophenolate mofetil (MMF) on pathological prognostic...

Steroid resistant focal segmental glomerulosclerosis: effect of arterial hyalinosis on outcome: single center study

Publié en ligne: 08 mai 2021

Pages: 127 - 133

Reçu: 27 juin 2020

DOI: https://doi.org/10.2478/rjim-2020-0045

Mots clés
cyclosporine, focal segmental glomerulosclerosis, steroid, fibrosis, proteinuria

© 2021 Amin R. Soliman et al., published by Sciendo

This work is licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.

Steroid resistant focal segmental glomerulosclerosis: effect of arterial hyalinosis on outcome: single center study

Publié en ligne: 08 mai 2021

Pages: 127 - 133

Reçu: 27 juin 2020

DOI: https://doi.org/10.2478/rjim-2020-0045

Mots cléscyclosporine, focal segmental glomerulosclerosis, steroid, fibrosis, proteinuria

© 2021 Amin R. Soliman et al., published by Sciendo

This work is licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.

Mots clés
cyclosporine, focal segmental glomerulosclerosis, steroid, fibrosis, proteinuria