Background: Cyclosporine is a calcineurin inhibitor that exhibits a notable steroid-sparing effect in patients with steroid-dependent nephrotic syndrome or those experiencing frequent relapses. Despite long-term cyclosporine use, it has been linked to an increased risk of unpleasant side effects, including nephrotoxicity, hypertension, and cosmetic symptoms like hirsutism and gum hypertrophy.

Aim: To assess effectiveness and side effects of cyclosporine in children diagnosed with steroid-dependent and frequent relapsing nephrotic syndrome at Sohag University Hospital.

Methods: We conducted a combined prospective and retrospective study at Pediatric nephrology clinic, Sohag University Hospital on children and adolescents diagnosed as steroid-dependent and frequent relapsing nephrotic syndrome who received cyclosporine as a steroid sparing agent.

Results: This study included total 50 nephrotic patients, there mean age was 11.4 ± 3.1 (4-15) years. Male: female ratio was 2.8:1. The mean disease duration was 7.0 ± 3.5 (1.3-14) years, and the mean cyclosporine use duration was 4.0 ± 2.6 (1-11) years. The average relapse number/patient/year significantly decreased by 82.6% following cyclosporine treatment, and the mean dependent steroid dose decreased by 69.19%.The recorded cyclosporine side effects were: hirsutism in 94%, gum hyperplasia in 38%, gastrointestinal disturbances in 32%, nephrotoxicity in 28% and new onset hypertension in 26% of cases. Histological nephrotoxicity was evident in 14 individuals (35.9%) of biopsied children.

Conclusion: Cyclosporine is deemed both safe and efficacious as a steroid-sparing medication for individuals with steroid-dependent and frequent relapsing nephrotic syndrome. Nonetheless, the safety of cyclosporine is not without exceptions, and various levels of side effects have been documented.