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Acute glomerular thrombosis with CsA treatment
N Muirhead1, D J Hollomby, P A Keown
1University Hospital, London, Ontario, Canada.
Insights
Cyclosporin A (CsA) can cause rare glomerular thrombosis in kidney transplant patients, leading to acute kidney injury. Prompt CsA withdrawal and streptokinase therapy reversed the condition, highlighting a critical, though speculative, CsA side effect.
Area of Science:
- Nephrology
- Transplantation Medicine
- Pharmacology
Background:
- Cyclosporin A (CsA) is a vital immunosuppressant in organ transplantation.
- Nephrotoxicity remains a significant concern with CsA therapy.
Observation:
- A case of acute glomerular thrombosis in a renal transplant recipient receiving CsA is presented.
- This thrombosis led to acute renal failure.
Findings:
- The patient's acute renal failure reversed after discontinuing CsA and receiving intra-arterial streptokinase.
- CsA-induced capillary thrombosis is a rare complication, potentially mimicking acute rejection post-transplant.
Implications:
- This case underscores the importance of recognizing CsA-induced glomerular thrombosis.
- Early diagnosis and intervention, including CsA withdrawal and thrombolytic therapy, can be crucial for renal recovery.
- The precise etiology of CsA-induced glomerular capillary thrombosis requires further investigation.
Abstract:
Cyclosporin A (CsA) is used widely as an immunosuppressive in organ transplantation. Although it is highly effective, acute and chronic nephrotoxicity of CsA are of continuing concern. A case of acute glomerular thrombosis secondary to CsA therapy in a renal transplant recipient is described. The course of the accompanying acute renal failure and its reversal following discontinuation of CsA and therapy with intra-arterial streptokinase is outlined. CsA-induced capillary thrombosis is rare but has been described in renal transplant recipients as well as in hepatic and bone marrow transplantation. It may give rise to diagnostic confusion in the early days following renal transplantation, where it may mimic acute rejection. The etiology of CsA-induced glomerular capillary thrombosis remains speculative.