Acute cyclosporin A induced nephrotoxicity in renal allografts

Immunosuppression with Cyclosporin A has resulted in dramatic improvements in the results of cadaveric kidney transplantation in Singapore. However, its major limitation is its nephrotoxicity which can appear in various forms after transplantation including a delay in graft function and chronic renal dysfunction. The clinical course of two patients with initial function but delayed onset of acute functional Cyclosporine nephrotoxicity are described. Recovery was documented in both cases with reduction of Cyclosporine dosage. A decline in renal blood flow and increase in renal vascular resistance is likely to have played a role in the pathogenesis of the acute functional nephrotoxicity. Cyclosporine induced imbalance in Prostaglandin synthesis within the kidney has been implicated.