Cyclosporine effectiveness and adverse outcomes in steroid dependent and frequent relapsing nephrotic syndrome in children

Background: Cyclosporine is a calcineurin inhibitor that exhibits a notable steroid-sparing effect in patients with steroid-dependent and frequent relapsing nephrotic syndrome. Despite long-term cyclosporine use, it has been linked to an increased risk of unpleasant side effects, including nephrotoxicity, hypertension, and cosmetic symptoms like hirsutism and gum hypertrophy. Aim: To assess the effectiveness and side effects of cyclosporine in children diagnosed with steroid-dependent and frequent relapsing nephrotic syndrome at Sohag University Hospital. Methods: This was a combined prospective and retrospective study which was conducted at Pediatric nephrology clinic, Sohag University Hospital on children diagnosed as steroid-dependent and frequent relapsing nephrotic syndrome who received cyclosporine as a steroid sparing agent. Results: This study included total 50 nephrotic patients, there mean age was 11.4 ± 3.1 (4-15) years. Male: female ratio was 2.8:1. The median disease duration was 7 years with interquartile range (3.88-9.63) years, and the median cyclosporine use duration was 4 years with interquartile range (1.5-6) years. The average relapse number/patient/year significantly decreased by 82.6% following cyclosporine treatment, and the mean dependent steroid dose decreased by 69.19%.The recorded cyclosporine side effects were: hirsutism in 94%, gum hyperplasia in 38%, gastrointestinal disturbances in 32%, nephrotoxicity in 28% and new onset hypertension in 26% of cases. Histological nephrotoxicity was evident in 14 individuals (35.9%) of biopsied children. Conclusion: Cyclosporine is deemed both safe and efficacious as a steroid-sparing medication for individuals with steroid-dependent and frequent relapsing nephrotic syndrome. Nonetheless, the safety of cyclosporine is not without exceptions, and various levels of side effects have been documented.