Response of calcineurin inhibitors therapy in frequently relapsing and steroid resistent nephrotic syndrome: A single-center experience

Abstract

Background and Objectives: This observational study was conducted to evaluate and compare the efficacy of calcineurin inhibitors in frequently relapsing nephrotic syndrome (FRNS) and steroid-resistant nephrotic syndrome (SRNS). Subjects and Methods: Each group comprised 15 patients who were studied prospectively. These patients were treated with tacrolimus (Tac) or cyclosporine (CSA) concomitant with prednisone, which was subsequently tapered off and stopped. The primary outcome variable was the number of patients who attained a complete remission (CR) or partial remission (PR). Results: Out of 15 patients with FRNS, 11 were children and 4 were adults. In SRNS, out of total 15 patients 7 were children and 8 were adults. There was male preponderance in FRNS children, whereas in SRNS, gender distribution was almost equal. Hypertension was more common in steroid-resistant group (80%) as compared to FRNS (33%). In FRNS, focal segmental glomerulosclerosis (FSGS), and immunoglobulin M variant of minimal change disease were the most common cause, each accounting for 5 patients, whereas FSGS (8 patients) was the most common etiology in SRNS. In FRNS, out of total 4 patients who were treated with CSA, 2 achieved CR and 2 achieved PR. Mean time to achieve remission was 3.2 months. In FRNS, out of 13 patients who were treated by Tac, 7 patients achieved CR and 6 patients achieved PR. Mean time to achieve remission was 2.1 months. In SRNS, out of 3 patients treated with CSA, 1 achieved PR whereas 2 patients did not respond. Time to achieve remission was 5 months. In SRNS, 11 of 14 patients achieved CR and 2 achieved PR. Mean time to achieve remission was 2.5 months. Among 2 patients resistant to CSA 1 achieved CR with Tac and one did not respond to Tac also. Conclusion: Thus, in FRNS patients, both CSA and Tac are almost equally effective whereas in SRNS patients Tac was more effective than CSA and was also effective in 1 patient resistant to CSA.