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NDT Advance Access originally published online on July 6, 2004
Nephrology Dialysis Transplantation 2004 19(9):2266-2271; doi:10.1093/ndt/gfh255
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Nephrol Dial Transplant Vol. 19 No. 9 © ERA-EDTA 2004; all rights reserved

Original Article

Concomitant administration of cyclosporine and ketoconazole in idiopathic nephrotic syndrome

Amr El-Husseini, Fathy El-Basuony, Ahmed Donia, Ihab Mahmoud, Nabil Hassan, Nagy Sayed-Ahmad and Mohamed Sobh

Urology and Nephrology Center, Mansoura, Egypt

Correspondence and offprint requests to: Prof. Dr Mohamed A. Sobh, MD, FACP. Prof. of Nephrology and Head of Nephrology Department, Urology and Nephrology Center Mansoura University Mansoura, Egypt. Email: afdonia{at}hotmail.com

Background. The deliberate use of ketoconazole to reduce the need for cyclosporine (CsA) is not new, but it is particularly relevant because of the high cost of CsA. Many studies have documented this benefit in renal and cardiac transplants, but this co-administration has not been reported in patients with nephrotic syndrome.

Methods. This retrospective study included 207 nephrotic patients who were steroid resistant, dependent or frequent relapsers and received CsA therapy. Among these patients 153 received daily ketoconazole therapy in a dose of 50 mg with concomitant decrease of one-third of the CsA dose while 54 patients received CsA alone. The majority of our cases were children (179 were below 18 years) and male to female ratio was 1.7:1.

Results. The great majority of the study population received the drugs for 1–2 years. Patients who received CsA and ketoconazole were comparable with those who received CsA alone regarding age, sex, duration of renal disease, renal pathology, severity of nephrotic syndrome, renal function, hepatic function and steroid response. Co-administration of ketoconazole significantly reduced mean doses of CsA by 37% after 1 month and 47% at 1 year with overall net cost savings of 37%. Hepatic functions remained within the normal range in both groups. Additionally, co-administration of ketoconazole significantly improved the response to CsA therapy, successful steroid withdrawal and decreased the frequency of renal impairment.

Conclusions. Co-administration of keto with CsA in idiopathic nephrotic patients significantly reduces CsA costs and may improve its response.

Keywords: cyclosporine; ketoconazole; nephrotic syndrome


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 Nephrol Dial TransplantHome page
A. El-Husseini, F. El-Basuony, I. Mahmoud, H. Sheashaa, A. Sabry, R. Hassan, N. Taha, N. Hassan, N. Sayed-Ahmad, and M. Sobh
Long-term effects of cyclosporine in children with idiopathic nephrotic syndrome: a single-centre experience
Nephrol. Dial. Transplant., November 1, 2005; 20(11): 2433 - 2438.
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