LAUSR

Methods: Patients with NS onset between age 1-60 years and diagnosed with SRNS between January 2010 and October 2015 (n=76) were included. All patients underwent renal biopsy and were started on either cyclosporine (CsA) at 4-5 mg/kg/day targeting whole blood trough levels of 80 120 ng/ml or tacrolimus (TAC) at 0.12-0.15 mg/kg/day targeting trough levels of 5-10 ng/ml. All patients were given steroids at a dose of 0.1-0.15mg/kg/day during therapy with CNIs. In patients who achieved complete remission (CR), TAC dose was reduced to achieve trough levels of 36ng/ml. All patients received maximum tolerable doses of ACEI/ ARBs. CNI therapy was continued for at least 6 months in all patients. CNIs were stopped at 6 months in patients who failed to achieve either CR/PR. In patients who had remission at 6 months, CNIs were continued for a minimum of 12 months. Of the total 76 patients, 30 were newly started on CNIs and had serum uPAR done at baseline and at 6 months and b3 integrin staining on renal biopsy was done. Results: Patients with age of onset of NS # 12 years of age were classified as childhood-onset NS (n=36) and those with age of onset >12 years of age (n=40) were classified as adult-onset NS. The commonest histology was focal segmental glomerular sclerosis-not otherwise specified (FSGS NOS) (n=45, 59.2%). Minimal change disease (MCD) was the second most common lesion (n=22, 28.9%). In our study, 86.8% of patients received TAC and 13.2% of patients received CsA. The CR at 6 months was 53% and 45% in childhood onset and adult onset SRNS respectively. The CR at 12 months was 66% and 68% in childhood onset and adult onset SRNS respectively. CNI resistance was 20%. AKI was the commonest adverse effect, seen in 16%, followed by infections (6.6%). suPAR levels at baseline did not differentiate between SRNS and SSNS or between FSGS and non-FSGS. The suPAR levels at 6 months of CNI therapy did not correlate with response or resistance to therapy. b3-integrin was negative(n=10) or trace to 1+ (n=12) in our patients with SRNS; their expression did not correlate with histology or response to CNIs.