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Established and newly proposed mechanisms of chronic cyclosporine nephropathy

Hye Eun Yoon1, Chul Woo Yang

  • 1Division of Nephrology, Transplantation research center, Seoul St. Mary's Hospital, The Catholic University of Korea, Seocho-gu, Seoul, Korea.

The Korean Journal of Internal Medicine
|June 23, 2009
PubMed

Insights

Cyclosporine (CsA) effectively treats transplant rejection and autoimmune diseases but can cause kidney damage. This review explores CsA nephropathy mechanisms and preventive strategies to mitigate renal injury.

Area of Science:

  • Nephrology
  • Immunology
  • Pharmacology

Background:

  • Cyclosporine (CsA) is vital for solid-organ transplantation and autoimmune disease management.
  • CsA use is limited by significant acute and chronic nephropathy, posing a major clinical challenge.
  • Acute CsA nephropathy involves reduced renal blood flow, while chronic mechanisms are complex.

Purpose of the Study:

  • To review current understanding of CsA-induced nephropathy.
  • To explore the multifaceted mechanisms underlying chronic CsA nephropathy.
  • To discuss preventive strategies for CsA-related renal injury.

Main Methods:

  • This review synthesizes existing literature on CsA nephropathy.
  • It examines implicated molecular and cellular pathways.
  • It discusses therapeutic interventions and preventative measures.

Main Results:

  • Chronic CsA nephropathy involves complex pathways including the renin-angiotensin system (RAS), endothelin-1, nitric oxide (NO) dysregulation, TGF-beta1 up-regulation, apoptosis, inflammation, and endoplasmic reticulum stress.
  • Dosage reduction and specific renoprotective agents may ameliorate CsA-induced renal injury.

Conclusions:

  • Understanding the diverse mechanisms of CsA nephropathy is crucial for effective management.
  • Preventive strategies, including dosage adjustment and adjunctive therapies, are essential to minimize renal damage.
  • Further research into CsA nephropathy pathogenesis can lead to improved patient outcomes.

Keywords:
Calcineurin inhibitorCyclosporineNephropathyNephrotoxicity

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