Cyclosporin nephrotoxicity: pathophysiology and comparison with FK-506

At the end of an era of almost exclusive use of cyclosporin A, there have been significant advances in the understanding of its immunosuppressive effects, whereas there is still uncertainty about the mechanisms underlying its nephrotoxicity. The recently introduced FK-506, in spite of its undeniable clinical advantages, has subsequently been proved to have rather similar nephrotoxicity. This paper reviews recent data on cyclosporin A and FK-506 nephrotoxicity, with emphasis on: first, the haemodynamic, functional and structural features; second, the potential mediators; and third, the relationship with some immunosuppressive mechanisms involved to give insights into the pathophysiology.