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Renal function and blood pressure in patients treated with cyclosporin A for uveitis
G Deray1, P Le Hoang, P Cacoub
1Department of Nephrology, Hôpital Pitié-Salpétrière, Paris, France.
Insights
Cyclosporin A (CyA) treatment for idiopathic uveitis significantly elevates serum creatinine, indicating kidney function impairment. While this effect is reversible upon stopping CyA, it may mask underlying chronic kidney damage and persistent hypertension.
Area of Science:
- Nephrology
- Ophthalmology
- Immunosuppressive Therapy
Background:
- Idiopathic uveitis requires immunosuppressive treatment.
- Cyclosporin A (CyA) is used for managing autoimmune conditions like idiopathic uveitis.
- Potential nephrotoxicity of CyA necessitates careful monitoring of renal function.
Purpose of the Study:
- To evaluate the impact of Cyclosporin A (CyA) on renal function in patients with idiopathic uveitis.
- To assess the reversibility of CyA-induced renal changes after treatment cessation.
- To investigate the relationship between CyA treatment, renal function, and hypertension.
Main Methods:
- Prospective evaluation of 21 patients with idiopathic uveitis receiving CyA for 9 months.
- Monitoring of serum creatinine levels before, during, and after CyA treatment.
- Assessment of blood pressure to detect hypertension development.
- Follow-up renal function and blood pressure measurements after CyA discontinuation.
Main Results:
- Serum creatinine significantly increased from baseline (82 mumol.l-1) after 1 month (111 mumol.l-1) and remained elevated (132 mumol.l-1) after 9 months of CyA treatment.
- Hypertension developed in 6 patients, often co-treated with corticosteroids.
- In 8 patients, serum creatinine normalized (decreased from 148 to 93 mumol.l-1) 3 months after stopping CyA, but 2 remained hypertensive.
Conclusions:
- Cyclosporin A induces a reversible increase in serum creatinine in patients with idiopathic uveitis.
- Reversibility of elevated creatinine does not exclude underlying histopathological renal lesions.
- Chronic renal damage from CyA may contribute to persistent hypertension even after treatment cessation.
Abstract:
Renal function has been evaluated in 21 patients treated with cyclosporin A (CyA) for 9 months for idiopathic uveitis. Serum creatinine, which was 82 mumol.l-1 before treatment, was significantly elevated after 1 month (111 mumol.l-1). After 9 months of treatment, and despite a decrease in CyA dosage, the mean plasma creatinine remained elevated at 132 mumol.l-1. Hypertension developed in 6 patients, five of them being concomitantly treated with corticosteroids. In 8 patients serum creatinine 3 months after CyA had been stopped had decreased from 148 to 93 mumol.l-1. Two of those patients remained hypertensive 3 months after CyA treatment had ceased. In patients with idiopathic uveitis CyA induces a reversible increase in serum creatinine. However the reversibility of such a biochemical marker does not preclude a histopathological lesion. Chronic renal damage may be responsible for the persistence of hypertension after cessation of CyA treatment.