comparison between the levels of cyclosporine CO and C2 in children undergoing renal transplantation

Cyclosporine A [CSA] with intra- and inter-individual variability in absorptive property needs individualized dose adjustment in patients receiving the drug. This study was performed to compare cyclosporine C0 [before morning dose] and C2 [two hours after morning dose] levels in order to adjust the maintenance dose of CSA in stable renal transplant patients in Shiraz, southern Iran. From October 2004 to June 2005, 64 kidney transplants of Nemazee Hospital entered our study. All patients underwent renal transplantation for the first time except one subject who received the second transplant. All patients received three immunosuppressive drugs of which CSA was administered in two divided doses in the form of microemulsion. The height, weight, blood pressure, periodical tests and C0 and C2 levels were determined at the time of referral, as well as one and 5 months later. The amount of CSA was adjusted based on C0 levels of 100-250 ng/mL. The patients were divided into two C0 subgroups with C0 levels of <100 and >/= 100 ng/mL. In regard to C2, the two subgroups were <800 and >/= 800 ng/mL. In addition to CSA, cellcept and prednisolone were administered to 47, immuran with prednisolone to 15, and only prednisolone to 2 patients. Comparing the two subgroups of C0 and C2, no differences were observed between serum creatinine level, CSA doage and the drug complications. A significant correlation was found between C0 and C2 levels, and also between C2 level and CSA dosage. A negative correlation was seen between C0 level and serum creatinine. The coefficient of variation of the three samples of each patient was 10.89% for C0, and 8.94% for C2 with constant drug regimen. As there was no significant difference between mean C0 and C2 levels, and renal function at the start and the end of study, there seemed to be no need to recommend C2 level for follow up of renal transplantation

Bone mineral density in children with relapsing nephrotic syndrome

Given the high relapse rate of disease in children with steroid dependent nephrotic syndrome and the osteoporotic effect of long periods of steroid therapy, this survey was performed to find the bone mineral status of these patients. Bone mineral density and content [BMD and BMC] were measured using Dual energy X-ray absorptiometry in 37 nephrotic children, six girls and 31 boys aged from four to 21- yrs, as patient group and 37 age and sex-matched healthy individuals as control group. Historical data were collected by chart review. As compared to the control group, the patients were shorter in stature. The percentage of BMC of lumbar and BMD of femoral bones of the patients was significantly lower than control group. According to the Warner method, 12% of the patients were osteoporotic and the BMD of their femoral and lumbar bones was inversely correlated with cumulative steroid dose. Bone loss can occur in some steroid-dependent nephrotic patients, especially those with low age of onset and those with longer duration of the disease and higher cumulative dose of steroid. Therefore, measurements of BMD and BMC could be recommended, at least, for the selected patients