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.jpg): Failed to open stream: No such file or directory in C:\Inetpub\vhosts\kidney.de\httpdocs\pget.php on line 117 Indian+J+Nephrol
2018 ; 28
(1
): 46-52
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gab.com Text
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Efficacy and Safety of Cyclosporine versus Tacrolimus in Steroid and
Cyclophosphamide Resistant Nephrotic Syndrome: A Prospective Study
#MMPMID29515301
Prasad N
; Manjunath R
; Rangaswamy D
; Jaiswal A
; Agarwal V
; Bhadauria D
; Kaul A
; Sharma R
; Gupta A
Indian J Nephrol
2018[Jan]; 28
(1
): 46-52
PMID29515301
show ga
Calcineurin inhibitors (CNIs) are the preferred drugs for treatment of childhood
steroid-resistant nephrotic syndrome (SRNS) who are also resistant to
cyclophosphamide (CYC). Although few studies have shown a benefit of one over the
other, efficacy and safety of either CNIs (tacrolimus [TAC] or cyclosporine
[CSA]) in this special population remained to be assessed in long-term studies.
Forty-five children with SRNS who were also resistant to CYC (CYC-SRNS) from
January 2006 to June 2011, were included in the study. Patients were treated with
CNI either TAC or CSA based on 1:1 allocations and were prospectively observed.
Patients who were nonresponsive to CNIs had been treated with mycophenolate
mofetil. Outcomes were measured in terms of remission of NS, adverse effects of
drugs, and progression of disease. After 6 months of treatment, 16/23 (69.5%)
patients on CSA achieved remission and 18/22 (81.8%) on TAC achieved remission (P
= 0.3). The side effects hypertrichosis, and gum hyperplasia were significantly
less in TAC group as compared to CSA group (P < 0.001). The 1-, 2-, 3-, 4-, and
5-year estimated renal survival (doubling of serum creatinine as event) in CSA
group was 96%, 91%, 85%, 54%, and 33% and in TAC group was 96%, 95%, 90%, 89%,
and 79%, respectively (P = 0.02). Although TAC and CSA are equally efficacious,
TAC has significantly less side effects. The long-term outcome of renal function
was significantly better in patients who were treated with TAC as compared to
CSA.