Cyclosporine For Refractory Nephritic Syndrome In Adults: A Systematic Review

Objective Refractory nephrotic syndrome, is classified as steroid resistant, steroid dependant and frequent relapses. Their management is difficult since patients are, on one hand, at risk for complications of unremitting nephrotic syndrome and progressive renal disease and on the other side effects of treatment with immunosuppressive medications. The aim of this systemic review was to assess whether cyclosporine is beneficial in the treatment of refractory nephritic syndrome.Methods The effect of cyclosprine in adults with refractory nephritic syndrome were identified by searching the Cochrane Library (Issue4,2009), PubMed, CNKI database, Chinese journals and books. Meta-analysis was performed using relative risk and risk difference for dichotomous data with 95%confidence intervals.Result Ten trials involving 435 patients were included in the analysis. Overall, there was evidence of a significant effect of cyclosporine on refractory nephritic syndrome in adult. Total remission of proteinuria (odds ratio 3.39; 95%confidence interval 2.25 to 5.09), complete remission (odds ratio 1.57; 95%confidence interval 0.87 to 2.82) and partial remission (odds ratio 3.64; 95%confidence interval 2.03 to 6.51) occurred in the cyclosporine group. Moreover, cyclosoprine had no effect on renal failure and the rate of hypertention.Conclusion In general, cyclosporine can improve the symptom for refractory nephritic syndrome in adult. It seemed to have a beneficial effect on the refractory nephritic syndrome in adults. But large, high-quality randomized controlled trials are needed to confirm or refuse the available evidence.