Renal Histopathologic Alterations in Patients Treated with Cyclosporine for Uveitis

Abstract

To evaluate abnormalities of renal morphology associated with long-term cyclosporine therapy, we obtained percutaneous renal biopsy specimens from 17 patients who had been treated for autoimmune uveitis with cyclosporine for an average of two years. For comparison, we also analyzed renal biopsy specimens from patients with idiopathic hematuria who had not received cyclosporine. The atrophic and sclerosing glomerular and tubulointerstitial lesions in the specimens were assessed to derive a chronicity index. The specimens from the patients treated with cyclosporine showed a significantly higher chronicity index than those from the controls (P less than 0.00005). All patients who had received cyclosporine had interstitial fibrosis, tubular atrophy, or both. A good functional predictor of the abnormalities in renal morphology was the length of time that a patient's serum creatinine had exceeded the base-line value by more than 50 percent. Chronic pathologic alterations were seen even in patients who had normal renal function at the time of the biopsy. In conjunction with sequential measurements of renal function, renal biopsy may have an important role in defining the type and degree of nephrotoxicity that can develop in patients receiving long-term cyclosporine therapy for autoimmune disease.

De novo hypertension after liver transplantation.

“…Renal vasoconstriction and impaired sodium excretion have been observed in these animal models without changes in arterial pressure (Table 4). Studies during long-term CSA administration in rats and rabbits demonstrate acquired resistance to the vasoconstrictive effects of norepinephrine and an- 62 The case presented in this article illustrates a feature not previously emphasized. By 2 years after transplant, blood pressure had fallen to normotensive levels despite continuation of both CSA and steroids and discontinuation of antihypertensive medications.…”

Cyclosporin‐A therapy in severe uveitis of Behçet's disease

“…Initially this drug has been used in relatively high doses, but nephrotoxic side effects have limited its use in high doses (Palestine et al 1986). Our understanding of dose-side effect interrelation has in recent years promoted us to use it in lower doses and in combination with other agents.…”

Long-term Treatment of Minimal-change Nephrotic Syndrome with Cyclosporin: A Control Biopsy Study

“…Thus, in non-fatal autoimmune diseases the risk and benefit of CsA therapy have to be evaluated. Dose-dependent nephrotoxicity is well known in all groups of patients treated with CsA including those with autoimmune diseases [15][16][17]. There was a slight increase of morphological scores in our control biopsies during treatment, but these findings were not so pronounced as to indicate CsA toxicity, and GFR remained unchanged during the observation period of 6-30 (mean 18) months.…”

“…CsA doses were considerably lower than in autoimmune patients in whom CsA toxicity has been reported [16,17].…”