Ciclosporin-induced partial and transient improvement of nephrotic syndrome in recurrent focal segmental glomerulosclerosis.

J.M. Morales, Servicio Nefrología, Hospital 12 Octubre, Ctra. Andalucia km 5.400, E-28041 Madrid (Spain) Dear Sir, Recently, it has been reported that ciclosporin (CsA) may be effective in the treatment of corticoresistant nephrotic syndrome, mainly in minimal change disease [1–3]. The usefulness of CsA in controlling nephrotic syndrome due to focal segmental glomerulosclerosis (FSGS) is controversial [1–3]. At the moment the clinical experience of CsA therapy in FSGS is scarce, especially in recurrent FSGS. We present herein the clinical data of a renal transplant patient with nephrotic syndrome due to recurrent FSGS. When CsA was started, a partial and transient clinical improvement maintained during 8 months was observed. Γ900 600 §5 1⁄8 < ? uí E 300 Case Report A 20-year-old woman was started on hemodialysis in 1983 because of FSGS. In May 1985 a cadaveric renal transplant was performed under prednisone and azathioprine treatment. The patient developed proteinuria following renal function recovery after a very prolonged period of acute tubular necrosis with evidence of acute rejection superimposed on it. In the 11th posttransplant month recurrent FSGS was clearly documented. The clinical and histologi-cal sequence of this recurrent FSGS was published before [4]. The last biopsy, performed because of renal function worsening and persistent nephrotic syndrome, showed focal segmental hyalinosis with IgM and C3 deposition in immunofluorescence. In addition, an important tubulointerstitial affection was evident [4]. Because of persistent clinical and biochemical nephrotic syndrome, 2 months later CsA (Sandimmune) was started. The initial dose was 12 mg/ kg/day orally, and then the dose was decreased. CsA blood through levels were determined by radioimmunoassay. At that moment a moderate renal failure (serum creatinine 2.2 mg/dl) was evident. Coincidental