Comparison of efficacy of tacrolimus versus cyclosporine in childhood steroid-resistant nephrotic syndrome

Objective: To compare the efficacy of tacrolimus versus cyclosporine [Calcineurin Inhibitors] in the management of childhood steroid-resistant nephritic syndrome [SRNS]

Study Design: Quasi-experimental study

Place and Duration of Study: Department of Paediatric Nephrology at The Children's Hospital and Institute of Child Health, Lahore, from August 2014 to September 2015

Methodology: Patients of either gender aged 1-12 years, with the diagnosis of mesangioproliferative glomerulonephritis [MesangioPGN], focal segmental glomerulosclerosis [FSGS] or minimal-change disease [MCD] were included. Patients were assigned into two groups, one given tacrolimus in dose of 0.1 - 0.2 mg/kg/day in two divided doses, and other given cyclosporine in dose of 150 - 200 mg/m2/day in two divided doses along with oral steroids 30 mg/m2/day in divided doses, followed by alternate day with tapering dosage. Trough drug levels were done with dose adjustment accordingly. Patients were monitored and followed for the response to treatment and adverse effects of these two calcineurin inhibitors

Results: A total of 84 patients, 58% males and 42% females, were included in the study. The age ranged from 1.25 to 12 years. The most common histopathological diagnosis was Mesangio PGN [69.04%], FSGS [21.4%], and MCD [9.52%].

Complete response was seen in 80.95% and 97.6% patients treated with cyclosporine and tacrolimus, respectively

Partial response was in 19.05% patients treated with cyclosporine and 2.4% in patients with tacrolimus. The most common adverse effect with cyclosporine and tacrolimus was hypertrichosis in 80.95% and 2.38%, hypertension 16.66% and 11.9% respectively while gum hypertrophy with cyclosporine was seen in 26.19% patients

Conclusion: Tacrolimus was more efficacious than cyclosporine in achieving remission in childhood SRNS with insignificant adverse effects

Chronic venous ulcers

Ulcers of the lower leg secondary to venous insufficiency account for some 85% of all leg ulcers. The proper venous drainage of a leg requires three sets of veins. Thee deep vein surrounded by muscles, the superficial veins, and the veins connecting these two - the perforating or communicating veins