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Minimal change nephropathy (MCN) accounts for around 25% of adults presenting with a nephrotic syndrome. Although most patients respond to corticosteroid therapy, a significant number relapse frequently and may present a real therapeutic difficulty. We present a case of apparently refractory relapsing MCN that was successfully treated with a combination of sirolimus and cyclosporin, resulting in the longest period of steroid free remission that the patient has ever experienced. To our knowledge, this is the first documented use of this combination in this manner.

The combined use of sirolimus and cyclosporin in the management of refractory minimal change nephropathy: 'a novel use of sirolimus'