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Related Experiment Videos

Cyclosporine-associated chronic nephropathy.

B D Myers, J Ross, L Newton

    The New England Journal of Medicine
    |September 13, 1984
    PubMed
    Summary

    Long-term cyclosporine therapy in heart transplant recipients significantly impairs glomerular filtration and renal plasma flow. This immunosuppressant may cause irreversible nephropathy, necessitating cautious use.

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    Area of Science:

    • Nephrology
    • Transplantation Immunology
    • Pharmacology

    Background:

    • Cyclosporine (cyclosporin A) is a vital immunosuppressant in organ transplantation.
    • Long-term effects of cyclosporine on renal function in heart transplant recipients require further investigation.

    Purpose of the Study:

    • To evaluate the impact of long-term cyclosporine therapy on glomerular filtration rate (GFR) and renal hemodynamics in heart transplant recipients.
    • To investigate the potential for cyclosporine-induced nephropathy.

    Main Methods:

    • Compared GFR and renal plasma flow in 17 heart transplant recipients on cyclosporine (≥12 months) versus 15 on azathioprine (≥12 months).
    • Assessed transglomerular transport of neutral dextrans and performed kidney histopathology.
    • Monitored for end-stage renal failure in a cohort of 32 long-term cyclosporine users.

    Main Results:

    • Cyclosporine recipients showed significantly depressed GFR (51 vs. 93 ml/min) and reduced renal plasma flow (320 vs. 480 ml/min) despite equivalent cardiac output.
    • Evidence suggested intrinsic glomerular capillary dysfunction rather than hemodynamic factors.
    • Histopathology revealed tubulointerstitial injury and focal glomerular sclerosis; 2/32 patients developed end-stage renal failure.

    Conclusions:

    • Long-term cyclosporine therapy is associated with significant nephrotoxicity in heart transplant recipients.
    • This nephropathy may be irreversible and progressive.
    • Cyclosporine should be used cautiously, and strategies to mitigate its renal toxicity are needed.

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