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On steroids for treatment of Focal Segmental Glomeruloscelrosis. What are the possible side effects?

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Nephrologist
Practicing since : 2001
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Hi, my pevious queries were replied by Dr XXXXXXX XXXXXXX
**********************
Hello Dr

Not sure if you will be able to access previous queries and replies. So to summarize...I was on steroids (Wysalone 75 mg per day) for treatment of Focal Segmental Glomeruloscelrosis.
We knew the side effects will happen but since it were getting too much (specially cataract) my nephrologist has no choice but to move to second line of treatment. My leg bones have also reduced to almost 2/3rd because of steroids.
He has now prescribed me Cyclophil ME capsules 200 mg per day (my weight is 70 kg currently).

- Need your views on this treatment.
- What are the possible side effects
- is this stronger than steroids
- If this is supposed to have less side effects than why is this called second line of treatment and why doctors prefer steroids to start with

I have also attached my test charts for your reference.

Thank you
Posted Sat, 28 Sep 2013 in Kidney Conditions
 
 
Answered by Dr. Avinash Ignatius 32 hours later
Brief Answer:
Dear XXXXXXX I'll answer each of your queries... (

Detailed Answer:
Dear XXXXXXX

I'll answer each of your queries...

(What are the possible side effects)

Increase in Blood Pressure, Sugars
Tremors,
Hirsuitism
Gum Hyperplasia

are some of the possible side effects.
But these are usually rare if the cyclosporine levels are kept in range.


-( is this stronger than steroids)

Yes these medicines are stronger and are actually used with steroids in transplantation. Need more monitoring. Risk of infections can be higher.

-( If this is supposed to have less side effects than why is this called second line of treatment and why doctors prefer steroids to start with)

The side effects are lesser because the dose for both steroids and cyclosporine is lower than what would have to be used individually.

The experience with use of steroids is of many many decades, and initial best responses are seen with steroids, while with cyclosporine the experience in nephrotic syndrome is relatively lesser. (maybe with time this combination may become first line)

(I have also attached my test charts for your reference.)

I have seen your reports, they suggest you are in partial remission. Sometimes it may not be possible to achieve complete remission, in-spite of using various combinations.

I would be fairly comfortable if your 24hr urinary protein levels are below 1000mg/day, without having to increase your meds too much, and risk adverse effects.

Regards
Above answer was peer-reviewed by
 
Follow-up: On steroids for treatment of Focal Segmental Glomeruloscelrosis. What are the possible side effects? 16 hours later
Dear Dr XXXXXXX

Thank you, you have been a great help for last 2-3 months in answering/clearing my doubts on the treatment and its effects.

- You mention that I may be in partial remission. So do you feel that a range of 640 mg/24 hrs of Urine protein and 4-5 RBCs in Urine is good enough to start tapering steroids without additional medicines !! Apart from BP and sugar I am worried for my bones. They have become thin, weak and lost strength in my knees. Can't rely on my knees that they will hold me in case of a fall.

- My weight is 70 kg currently ...... 5 kgs lost since start of treatment :). Is 200 mg per day of Cyclophil ok for me !! and this is along with wysolone as of now.

-Though tapering of steroid will start from this weekend, I feel this alternate medicine should start after some time once the side effects are under control. In fact from last 2 dys my BP is in range of 130-140/90-100. But I am not a doctor and my nephrologist knows best and its his call.

-My vision is really creating problem for me in office. Though I will speak to me opthalmologist for cataract surgery.... can it be performed with this Cyclophil being taken or have to wait for it to be stopped.

I have many more queries in my mind but can't word everything here. Still trying to accept these side effects which are killing at times. And waiting for new side effects of Cyclosporine to start :)

Thank you once again for your views/clarification.
 
 
Answered by Dr. Avinash Ignatius 2 days later
Brief Answer:
Dear XXXXXXX

Detailed Answer:
Your weight in the beginning woul be due to water retention, and as the water is lost in response to treatment you will loose a couple of kg's.

The blood level of cyclosporine will have to be checked after about a week of starting it, and your nephrologist will modify the dose accordingly. Wysolone dose will need to be reduced (however should not be stopped completely).

BP should come down as the steroid dose is reduced.

Cataract surgery can be done with Cyclosporine, and the new lens does not get affected with medicine.

Im sure once the dose of steroids is reduced you'll feel much better..

Regards
Above answer was peer-reviewed by
 
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