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NDT Advance Access originally published online on April 6, 2005
Nephrology Dialysis Transplantation 2005 20(6):1032-1034; doi:10.1093/ndt/gfh803
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© The Author [2005]. Published by Oxford University Press on behalf of ERA-EDTA. All rights reserved. For Permissions, please email: journals.permissions@oupjournals.org

Editorial Comment

How should microemulsified Cyclosporine A (Neoral®) therapy in patients with nephrotic syndrome be monitored?

Guido Filler

Department of Pediatrics, Children's Hospital of Eastern Ontario, 401 Smyth Road, Ottawa, ON K1H 8L1, Canada

Correspondence and offprint requests to: Guido Filler, Division of Nephrology, Department of Pediatrics, Children's Hospital of Eastern Ontario, Ottawa, Ontario K1H 8L1, Canada. Email: filler@cheo.on.ca

Keywords: Cyclosporine A; Sandimmune Neoral; Nephrotic syndrome; Steroid-resistant nephrotic syndrome; Pharmacokinetics

The first 10% of the full text of this article appears below.



   Introduction
 
Cyclosporine A (CyA) has been used empirically for almost two decades in the treatment of severe forms of idiopathic nephrotic syndrome (NS), in both children and adults [1]. The mechanism of CyA's action remains unclear. It may be related to immunosuppressive or haemodynamic properties, or have an effect on heparan sulfate, the main component of the glomerular charge barrier [2]. Initially, the therapy was performed with ‘classic’ Cyclosporine (Sandimmune®). Because of substantial inter- and intra-patient variability and a narrow therapeutic window, therapeutic drug monitoring of Cyclosporine therapy is mandatory [3,4]. With ‘classic’ CyA, trough level monitoring was recommended.

In the mid-1990s a microemulsified (ME) formulation of Cyclosporine (Neoral®) became available and many patients were converted because of . . . [Full Text of this Article]



   Pharmacokinetics of CyA ME in patients with NS
 


   Uncertainty about the target AUC and target C2 concentrations
 


   Conclusions
 

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