cutaneous microvascular lesion related to disturbed local and/or systemic regulation of skin microcirculation. Blood flow in the microcirculation is controlled by three major elements: vascular smooth muscle cell tone, endothelial function and sympathetic innervation [11]. Cyclosporine A use was found to affect sympathetic nervous system activity as well as endothelial function [5, 7, 12, 13]. Since sympathetic nerve activity is a major determinant of vascular tone, peripheral vascular function assessment should include measurements of both vascular reactivity and sympathetic activity [11]. To fully investigate the direct effect of CsA on these parameters the potential influence of administration of additional drugs should be excluded. However, steroids are used very frequently with CsA and complete removal should be avoided. The aim of the study was to determine the effect of long-term CsA treatment in children with idiopathic nephrotic syndrome on peripheral blood flow as assessed with thermography and autonomic nerve function. Material and methods Subjects The study group consisted of 19 children (11 M, 8 F; mean age 10.8 ±4.4 years) with mean duration Table I. Selected clinical data from the cyclosporine A treated and healthy children Data Number of patients Male/female Age [years] BMI [kg/m2] Systolic blood pressure [mmHg] Diastolic blood pressure [mmHg] NS treatment [months] eGFR [ml/min/1.73 m BSA] CsA treatment [months] Mean CsA [ng/ml] Haemoglobin [g/l] Albumin [g/l] Response to steroid therapy: • steroid dependency • steroid resistance Histology at onset of NS: • MCD • FSGS Nephrotoxicity on renal biopsy [patients] Hypertension [patients] * significantly different vs. controls p < 0.05 574 Aneta Czupryniak, Anna Kałużyńska, Anna Półtorak-Krawczyk, Bartosz Ostrowski, Bogusław Więcek, Marcin Tkaczyk of nephrotic syndrome 6.3 ±4.1 years. All subjects from the study group were treated with CsA for at least 6 months, mean 44.5 ±27.6 months. Other medication included prednisone (30% of patients, mean dose 0.5 mg/kg/day). Five patients in the study group were hypertensive and they were all treated with angiotensin-converting enzyme (ACE) inhibitors in monotherapy. Subjects with cardio- vascular disease other than hypertension, postural hypotension, hypo- or hyperthyroidism, and inter- current infection were excluded from the study. All patients were in the remission of nephrotic syndrome defined by normal plasma albumin level with no proteinuria when the study procedures were performed. Sixteen healthy age- and gender-matched children served as controls. The clinical characte- ristics of the groups are presented in Table I. Procedures Thermographic imaging Vascular function studies were carried out in the morning after a 12-h fast. The assessment of blood flow was made based on the results of thermographic measurements during the cold stress test (CST). The infrared radiation registering device Inframetrics PM290 camera (Inframetrics Corp., Billerica, Mass., USA) was used for registration. Data acquisition and analysis were conducted using software prepared by the Institute of Electronics, Technical University of Lodz [14]. The software was used to calculate mean temperature in the predefined skin areas and temperature time trend projections, thus enabling precise temperature change assessment in various parts of the body. The thermographic assessment was performed according to the method described by Ammer and Ring [14]. In short, a standard thermogram of the dorsal surface of both hands was recorded after 15-min equilibration in a draught-free room at a controlled temperature of 22°C. The hands were then placed on a thin board at heart level. The CST was performed by covering the hands with gloves and immersing them into a large bowl of water at 20°C for 1 min. Afterwards the temperature of both hands was recorded by infrared camera every 10 s for 10 min. The metacarpal region and finger region were predefined for the purpose of temperature change assessment. Temperature recorded in the finger region was the mean for five fingers. Peripheral blood flow disturbances were assessed with dynamic temperature changes registration and characterized as the temperature increase rate in the first 5 min after CST. A gradient between the finger and metacarpal regions greater than 4°C after 10 min of CST was con- sidered diagnostic for RP [15]. Arch Med Sci 4, August / 2010 Study group Controls 10.8 ±4.4 11.7 ±3.8 20.9 ±5.5 18.5 ±2.6 19 11/8 118 ±11* 75 ±6* 75.6 ±49.2 128 44.5 ±27.6 70.9 ±47.0 133 ±9 33 ±4 18 1 18 1 2 5* 16 10/6 112 ±3 71 ±3 135 136 ±11 35 ±5 – – – – – – 0*