Cyclosporine-Associated Chronic Nephropathy
- 13 September 1984
- journal article
- Published by Massachusetts Medical Society in The New England Journal of Medicine
- Vol. 311 (11), 699-705
- https://doi.org/10.1056/nejm198409133111103
Abstract
We evaluated glomerular filtration in 17 recipients of heart transplants who were treated for 12 months or longer with cyclosporine (cyclosporin A). The control group consisted of 15 heart-transplant recipients who were treated with azathioprine and who had also survived for at least 12 months. Despite an equivalent cardiac output, the glomerular filtration rate was depressed (51±4 vs. 93±3 ml per minute, P<0.005) in transplant recipients treated with cyclosporine. Cyclosporine treatment was also associated with reduced renal plasma flow (320±21 vs. 480±30 ml per minute, P<0.001). A trend toward restricted transglomerular transport of neutral dextrans (radii, 2.4 to 5.8 nm) in cyclosporine-treated recipients suggested an intrinsic loss of ultrafiltration capacity by glomerular capillaries rather than a hemodynamic basis for the reduced glomerular filtration rate. Histopathologic examination of the kidneys of five cyclosporine-treated patients with glomerular hypofiltration revealed a variable degree of tubulointerstitial injury accompanied by focal glomerular sclerosis. Among the 32 heart-transplant recipients treated for more than 12 months with cyclosporine at our center, end-stage renal failure developed in 2. We conclude that long-term cyclosporine therapy may lead to irreversible and potentially progressive nephropathy. We recommend that cyclosporine be used with restraint and caution until ways are found to mitigate its nephrotoxicity. (N Engl J Med 1984; 311: 699–705.)Keywords
This publication has 26 references indexed in Scilit:
- Cyclosporine: Five Years' Experience in Cadaveric Renal TransplantationThe New England Journal of Medicine, 1984
- Cyclosporine NephrotoxicityAnnals of Internal Medicine, 1983
- CYCLOSPORIN IN CADAVERIC RENAL TRANSPLANTATION: ONE-YEAR FOLLOW-UP OF A MULTICENTRE TRIALThe Lancet, 1983
- A Randomized Clinical Trial of Cyclosporine in Cadaveric Renal TransplantationThe New England Journal of Medicine, 1983
- A CONTROLLED TRIAL OF CYCLOSPORINE IN RENAL TRANSPLANTATION WITH CONVERSION TO AZATHIOPRINE AND PREDNISOLONE AFTER THREE MONTHSTransplantation, 1983
- CYCLOSPORIN-A DEPOSITS IN RENAL ALLOGRAFTSThe Lancet, 1983
- Increased Inactive Renin in Diabetes Mellitus without Evidence of Nephropathy*Journal of Clinical Endocrinology & Metabolism, 1983
- Mechanisms of proteinuria in human glomerulonephritis.JCI Insight, 1982
- RENAL EXTRACTION OF PARA‐AMINOHIPPURATE AND CREATININE MEASURED BY CONTINUOUS IN VIVO SAMPLING OF ARTERIAL AND RENAL‐VEIN BLOODAnnals of the New York Academy of Sciences, 1962
- Determination of Dextran with AnthroneAnalytical Chemistry, 1953