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Erschienen in: Wiener klinische Wochenschrift 15-16/2017

01.08.2017 | short report

Neurotoxicity of cyclosporine A in children with steroid-resistant nephrotic syndrome: is cytotoxic edema really an unfavorable predictor of permanent neurological damage?

verfasst von: MD, PhD Danica Batinić, Danko Milošević, Boris Filipović-Grčić, Marija Topalović-Grković, Nina Barišić, Daniel Turudić

Erschienen in: Wiener klinische Wochenschrift | Ausgabe 15-16/2017

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Summary

Background

Cyclosporine A-associated neurotoxicity has been reported mainly after organ transplantation. Only a small number of children with steroid-resistant nephrotic syndrome and cyclosporine A-associated neurotoxicity have been reported.

Patients

We report three children, aged 4, 11, and 15, with steroid-resistant nephrotic syndrome and cyclosporine A-associated neurotoxicity. In two of the patients, primary diagnosis was idiopathic nephrotic syndrome, and in one it was IgA nephropathy. Magnetic resonance with diffusion-weighted imaging, combined with quantification of apparent diffusion coefficient values, showed lesions caused by cytotoxic edema indicating irreversible brain damage. Nonetheless, the patients fully recovered clinically and radiologically after prompt discontinuation of cyclosporine A.

Conclusions

Neurotoxic effects should be suspected in any child with nephrotic syndrome treated with cyclosporine A in whom sudden neurological symptoms occur. Cytotoxic edema is a rare finding in pediatric patients. However, even in such cases with seemingly irreversible brain damage, full recovery without permanent neurological sequels is possible with prompt cyclosporine A discontinuation and supportive therapy.

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Literatur
1.
Zurück zum Zitat Gijtenbeek JM, van den Bent MJ, Vecht CJ. Cyclosporine neurotoxicity: a review. J Neurol. 1999;246:339–46. CrossRefPubMed Gijtenbeek JM, van den Bent MJ, Vecht CJ. Cyclosporine neurotoxicity: a review. J Neurol. 1999;246:339–46. CrossRefPubMed
2.
Zurück zum Zitat Lombel RM, Hodson EM, Gipson DS. Treatment of steroid-resistant nephrotic syndrome in children: new guidelines from KDIGO. Pediatr Nephrol. 2013;28:409–14. CrossRefPubMed Lombel RM, Hodson EM, Gipson DS. Treatment of steroid-resistant nephrotic syndrome in children: new guidelines from KDIGO. Pediatr Nephrol. 2013;28:409–14. CrossRefPubMed
3.
Zurück zum Zitat Jeong MH, Lee JH, Yum MS, Ko TS, Park SY. A case of posterior reversible encephalopathy syndrome during cyclosporine therapy in a child with steroid resistant nephrotic syndrome. J Korean Soc Pediatr Nephrol. 2007;11:92–9. CrossRef Jeong MH, Lee JH, Yum MS, Ko TS, Park SY. A case of posterior reversible encephalopathy syndrome during cyclosporine therapy in a child with steroid resistant nephrotic syndrome. J Korean Soc Pediatr Nephrol. 2007;11:92–9. CrossRef
4.
Zurück zum Zitat Saeed B, Abou-Zor N, Amer Z, Kanani I, Hilal M. Cyclosporin-A induced posterior revesible encephalopathy syndrome. Saudi J Kidney Dis Transpl. 2008;19:439–42. PubMed Saeed B, Abou-Zor N, Amer Z, Kanani I, Hilal M. Cyclosporin-A induced posterior revesible encephalopathy syndrome. Saudi J Kidney Dis Transpl. 2008;19:439–42. PubMed
5.
Zurück zum Zitat Sakai N, Kawasaki Y, Imaizumi T, Kanno S, et al. Two patients with focal segmental glomerulosclerosis complicated by cyclosporine-induced reversible posterior leukoencephalopathy syndrome. Clin Nephrol. 2010;73:482–6. CrossRefPubMed Sakai N, Kawasaki Y, Imaizumi T, Kanno S, et al. Two patients with focal segmental glomerulosclerosis complicated by cyclosporine-induced reversible posterior leukoencephalopathy syndrome. Clin Nephrol. 2010;73:482–6. CrossRefPubMed
6.
Zurück zum Zitat Taque S, Peudenier S, Gie S, et al. Central neurotoxicity of cyclosporine in two children with nephrotic syndrome. Pediatr Nephrol. 2004;19:276–80. CrossRefPubMed Taque S, Peudenier S, Gie S, et al. Central neurotoxicity of cyclosporine in two children with nephrotic syndrome. Pediatr Nephrol. 2004;19:276–80. CrossRefPubMed
7.
Zurück zum Zitat Zhang Y, Zhou J, Chen Y. Posterior reversible encephalopathy syndrome in a child with steroid-resistant nephrotic syndrome: a case report and review of literature. Int J Clin Exp Pathol. 2014;7:4433–7. PubMedPubMedCentral Zhang Y, Zhou J, Chen Y. Posterior reversible encephalopathy syndrome in a child with steroid-resistant nephrotic syndrome: a case report and review of literature. Int J Clin Exp Pathol. 2014;7:4433–7. PubMedPubMedCentral
8.
Zurück zum Zitat Ishikura K, Hamasaki Y, Skai T, Hataya H, Mak RH, Honda M. Posterior reversible encephalopathy syndrome in children with kidney diseases. Pediatr Nephrol. 2012;27:375–84. CrossRefPubMed Ishikura K, Hamasaki Y, Skai T, Hataya H, Mak RH, Honda M. Posterior reversible encephalopathy syndrome in children with kidney diseases. Pediatr Nephrol. 2012;27:375–84. CrossRefPubMed
9.
Zurück zum Zitat Iyer RS, Chaturvedi A, Pruthi S, Khanna PC, Ishak GE. Medication neurotoxicity in children. Pediatr Radiol. 2011;41:1455–64. CrossRefPubMed Iyer RS, Chaturvedi A, Pruthi S, Khanna PC, Ishak GE. Medication neurotoxicity in children. Pediatr Radiol. 2011;41:1455–64. CrossRefPubMed
10.
Zurück zum Zitat Ishikura K, Hamasaki Y, Sakai T, et al. Children with posterior reversible encephalopathy syndrome associated with atypical diffusion-weighted imaging and apparent diffusion coefficient. Clin Exp Nephrol. 2011;15:275–80. CrossRefPubMed Ishikura K, Hamasaki Y, Sakai T, et al. Children with posterior reversible encephalopathy syndrome associated with atypical diffusion-weighted imaging and apparent diffusion coefficient. Clin Exp Nephrol. 2011;15:275–80. CrossRefPubMed
Metadaten
Titel
Neurotoxicity of cyclosporine A in children with steroid-resistant nephrotic syndrome: is cytotoxic edema really an unfavorable predictor of permanent neurological damage?
verfasst von
MD, PhD Danica Batinić
Danko Milošević
Boris Filipović-Grčić
Marija Topalović-Grković
Nina Barišić
Daniel Turudić
Publikationsdatum
01.08.2017
Verlag
Springer Vienna
Erschienen in
Wiener klinische Wochenschrift / Ausgabe 15-16/2017
Print ISSN: 0043-5325
Elektronische ISSN: 1613-7671
DOI
https://doi.org/10.1007/s00508-017-1221-z