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Cyclosporine-Associated Nephrotoxicity

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DOI: 10.4236/ojneph.2013.33030    5,246 Downloads   8,029 Views   Citations

ABSTRACT

Cyclosporine (CsA) has revolutionized transplant medicine and is currently one of the most important immunosuppressive agents for a wide range of organ transplantations and of autoimmune and inflammatory diseases, such as rheumatoid arthritis, uveitis, psoriasis, and atopic dermatitis. Renal impairment represents the main limitation to CsA long-term continuous therapy. However, it has been shown that nephrotoxicity is associated with longer treatment duration, larger cumulative doses and higher daily dose of CsA. With low dose regimens (<5 mg/kg/day), stable serum creatinine levels have been observed up to 15-20 years after kidney transplantation. Intermittent therapy may offer a good therapeutic strategy to limit long-term renal dysfunction, given the fact that renal structural changes are dose- and time-dependent. The best predictor of permanent renal damage is a persistent increase in serum creatinine level one month after treatment withdrawal. In patients with autoimmune diseases, the percentage increase in serum creatinine above baseline value during CsA therapy has been shown to predict CsA-induced nephropathy. Before CsA therapy initiation, patients should undergo a thorough baseline evaluation including laboratory assessments, in particular electrolytes, serum creatinine, and urea levels. Furthermore, patients should be evaluated for factors that might increase the risk of nephrotoxicity, such as obesity, older age, hypertension, concomitant use of nephrotoxic drugs, and pre-existing renal conditions. In the present paper, CsA-induced nephropathy will be reviewed in terms of pathophysiology, pathologic and clinical findings, and strategies for prevention and management.

Conflicts of Interest

The authors declare no conflicts of interest.

Cite this paper

M. Colombo, R. Perego and G. Bellia, "Cyclosporine-Associated Nephrotoxicity," Open Journal of Nephrology, Vol. 3 No. 3, 2013, pp. 168-180. doi: 10.4236/ojneph.2013.33030.

References

[1] [1] D. Tedesco and L. Haragsim, “Cyclosporine: A Review,” Journal of Transplantation, 2012, Article ID 230386, 2012, 7 pages.
[2] J. F. Borel, “Comparative Study of in Vitro and in Vivo Drug Effects on Cell Mediated Cytotoxicity,” Immunology, Vol. 31, No. 4, 1976, pp. 631-641.
[3] S. Hariharan, C. P. Johnson, B. A. Bresnahan, S. E. Taranto, M. J. McIntosh and D. Stablein, “Improved Graft Survival after Renal Transplantation in the United States 1988-1996,” The New England Journal of Medicine, Vol. 342, 2000, pp. 605-612. doi:10.1056/NEJM200003023420901
[4] G. Feutren and M. J. Mihatsch, “Risk Factors for Cyclosporine-Induced Nephropathy in Patients with Autoimmune Diseases,” The New England Journal of Medicine, Vol. 326, 1992, pp. 1654-1660. doi:10.1056/NEJM199206183262502
[5] F. Rodriguez, J. C. Krayenbuehl, W. B. Harrison, O. Forre, B. A. C. Dijkmans, P. Tugwell, et al., “Renal Biopsy Findings and Follow Up of Renal Function in Rheumatoid Arthritis Patients Treated with Cyclosporine A. An Update from the International Kidney Biopsy Register,” Arthritis & Rheumatism, Vol. 39, No. 9, 1996, pp. 1491-1498. doi:10.1002/art.1780390908
[6] C. Isnard Bagnis, S. Tezenas du Montcel, H. Beaufils, C. Jouanneau, C. Jaudon, P. Macsud, et al., “Long-Term Renal Effects of Low-Dose Cyclosporine in Uveitis-Treated Patients: Follow-Up Study,” Journal of the American Society of Nephrology, Vol. 13, No. 12, 2002, pp. 2962-2968. doi:10.1097/01.ASN.0000034945.61533.26
[7] C. E. M. Griffiths, L. Dubertret, C. N. Ellis, A. Y. Finlay, A. F. Finzi, V. C. Ho, et al., “Cyclosporin in Psoriasis Clinical Practice: An International Consensus Statement,” British Journal of Dermatology, Vol. 150, No. 67, 2004, pp. 11-23. doi:10.1111/j.0366-077X.2004.05949.x
[8] J. I. Harper, J. Berth-Jones, R. D. Camp, M. J. Dillon, A. Y. Finlay, C. A. Holden, et al., “Cyclosporin for Atopic Dermatitis in Children,” Dermatology, Vol. 203, No. 1, 2001, pp. 3-6. doi:10.1159/000051694
[9] R. Y. Calne, S. Thiru and D. J. G. White, “Cyclosporin A in Patients Receiving Renal Allografts from Cadaver Donors,” Lancet, Vol. 2, No. 8104, 1978, pp. 1323-1327.
[10] R. Kandaswamy, A. Humar, V. Casingal, K. J. Gillingham, H. Ibrahim and A. J. Matas, “Stable Kidney Function in the Second Decade after Kidney Transplantation While on Cyclosporine-Based Immunosuppression,” Transplantation, Vol. 83, No. 6, 2007, pp. 722-726 doi:10.1097/01.tp.0000256179.14038.e2
[11] G. Klintmalm, S. O. Bohman, B. Sundelin and H. Wiczek, “Interstitial Fibrosis in Renal Allografts after 12 to 46 Months of Cyclosporine Treatment: Beneficial Effects of Low Doses in Early Post-Transplantation Period,” Lancet, Vol. 2, No. 8409, 1984, pp. 950-954 doi:10.1016/S0140-6736(84)91166-8
[12] G. Klintmalm, J. Sawe, O. Ringden, B. C. Von Bahr and A. Magnusson, “Cyclosporine Plasma Levels in Renal Transplant Patients. Association with Renal Toxicity and Allograft Rejection,” Transplantation, Vol. 39, No. 2, 1985, pp. 132-137. doi:10.1097/00007890-198502000-00005
[13] F. C. Henny, C. H. Kleinbloesem, A. J. Moolenaar, L. C. Paul, D. D. Breimaer and L. A. van Es, “Pharmacokinetics and Nephrotoxicity of Cyclosporine in Renal Transplant Recipients,” Transplantation, Vol. 40, No. 3, 1985, pp. 261-265. doi:10.1097/00007890-198509000-00008
[14] R. J. Ptachcinski, G. J. Burckart and R. Venkataramanan, “Cyclopsorine Concentration Determinations for Monitoring and Pharmacokinetic Studies,” The Journal of Clinical Pharmacology, Vol. 26, No. 5, 1986, pp. 358-366. doi:10.1002/j.1552-4604.1986.tb03538.x
[15] A. Fahr, “Cyclosporine Clinical Pharmacokinetics,” Clinical Pharmacokinetics, Vol. 24, No. 6, 1993, pp. 472-495. doi:10.2165/00003088-199324060-00004
[16] D. W. Holt, E. A. Mueller, J. M. Kovarik, J. B. van Bree, F. Richard and K. Kutz, “Sandimmun Neoral Pharmacokinetics: Impact of the New Oral Formulation,” Transplant Proceeding, Vol. 27, No. 1, 1995, pp. 1434-1437.
[17] M. A. Masri, A. Barbari, A. Stephan, G. Kamel, G. Frem, F. Younan, et al., “Cyclosporine Pharmacokinetics in Stable Renal Transplant Patients: Effect of Formulation Sandimmun versus Consupren versus Neoral,” Transplant Proceeding, Vol. 28, No. 3, 1996, pp. 1318-1320.
[18] H. Humbert, “Variability of the Bioavailability of Cyclosporine: Benefit of the Neoral Formulation,” Therapie, Vol. 52, No. 4, 1997, pp. 353-357.
[19] M. Naesens, D. R. J. Kuypers and M. Sarwal, “Calcineurin Inhibitors Nephrotoxicity,” Clinical Journal of the American Society of Nephrology, Vol. 4, No. 2, 2009, pp. 481-508.
[20] P. F. Halloran, L. M. Helms, L. Kung and J. Noujaim, “The Temporal Profile of Calcineurin Inhibition by Cyclosporine in Vivo,” Transplantation, Vol. 68, No. 9, 1999, pp. 1356-1361.doi:10.1097/00007890-199911150-00023
[21] K. Iwasaki, T. Shiraga, H. Matsuda, Y. Teramura, A. Kawamura, T. Hata, et al., “Absorption, Distribution, Metabolism and Excretion of Tacrolimus (FK506) in the Rat,” Drug Metabolism and Pharmacokinetics, Vol. 13, No. 3, 1998, pp. 259-265. doi:10.2133/dmpk.13.259
[22] M. Kubo, Y. Kiyohara, I. Kato, Y. Tanizaki, R. Katafuchi, H. Hirakata, et al., “Risk Factors for Renal Glomerular and Vascular Changes in an Autopsy-Based Population Survey: The Hisayama Study,” Kidney International, Vol. 63, 2003, pp. 1508-1515. doi:10.1046/j.1523-1755.2003.00886.x
[23] N. D. Sturrock, C. C. Lang and A. D. Struthers, “Indomethacin and Cyclosporine Together Produce Marked Renal Vasoconstriction in Humans,” Journal of Hypertension, Vol. 12, No. 8, 1994, pp. 919-924. doi:10.1097/00004872-199408000-00009
[24] R. D. Altman, G. O. Perez and G. N. Sfakianakis, “Interaction of Cyclosporine A and Nonsteroidal Anti-Inflammatory Drugs on Renal Function in Patients with Rheumatoid Arthritis,” The American Journal of Medicine, Vol. 93, No. 4, 1992, pp. 396-402. doi:10.1016/0002-9343(92)90169-C
[25] J. M. Kovarik, P. Kurki, E. Mueller, M. Guerret, E. Markert, R. Alten, et al., “Diclofenac Combined with Cyclosporine in Treatment Refractory Rheumatoid Arthritis: Longitudinal Safety Assessment and Evidence of a Pharmacokinetic/Dynamic Interaction,” Journal of Rheumatology, Vol. 23, No. 12, 1996, pp. 2033-2038.
[26] R. M. Soubhia, G. E. Mendes, F. Z. Mendonca, M. A. Baptista, J. P. Cipullo and E. A. Burdmann, “Tacrolimus and Nonsteroidal Anti-Inflammatory Drugs: An Association to Be Avoided,” American Journal of Nephrology, Vol. 25, 2005, pp. 327-334. doi:10.1159/000086569
[27] C. C. Baan, A. H. Balk, C. T. Holweg, I. C. van Riemsdijk, L. P. Maat, P. J. Vantrimpont, et al., “Renal Failure after Clinical Heart Transplantation Is Associated with the TGF-beta 1 Codon 10 Gene Polymorphism,” Journal of Heart Lung Transplant, Vol. 19, No. 9, 2000, pp. 866-872. doi:10.1016/S1053-2498(00)00155-8
[28] J. van de Wetering, C. H. Weimar, A. H. Balk, J. I. Roodnat, C. T. Holweg, C. C. Baan, et al., “The Impact of Transforming Growth Factor-Beta1 Gene Polymorphism on End-Stage Renal Failure after Heart Transplantation,” Transplantation, Vol. 82, No. 12, 2006, pp. 1744-1748. doi:10.1097/01.tp.0000250360.78553.5e
[29] S. Di Filippo, A. Zeevi, K. K. McDade, G. J. Boyle, S. A. Miller, S. K. Gandhi and S. A. Webber, “Impact of TGFbeta1 Gene Polymorphisms on Late Renal Function in Pediatric Heart Transplantation,” Human Immunology, Vol. 66, No. 2, 2005, pp. 133-139. doi:10.1016/j.humimm.2004.09.018
[30] J. R. Jonsson, C. Hong, D. M. Purdie, C. Hawley, N. Isbel, M. Butler, et al., “Role of Cytokine Gene Polymorphisms in Acute Rejection and Renal Impairment after Liver Transplantation,” Liver Transplant, Vol. 7, No. 3, 2001, pp. 255-263. doi:10.1053/jlts.2001.22450
[31] J. Mytilineos, G. Laux and G. Opelz, “Relevance of IL10, TGF-beta1, TNFalpha, and IL4Ralpha Gene Polymorphisms in Kidney Transplantation: A Collaborative Transplant Study Report,” American Journal of Transplantation, Vol. 4, No. 10, 2004, pp. 1684-1690. doi:10.1111/j.1600-6143.2004.00561.x
[32] B. Rigat, C. Hubert, F. Henc-Gelas, F. Cambien, P. Corvol and F. Soubrier, “An Insertion/Deletion Polymorphism in the Angiotensin I-Converting Enzyme Gene Accounting for Half the Variance of Serum Enzyme Levels,” Journal of Clinical Investigation, Vol. 86, No. 4, 1990, pp. 1343-1346. doi:10.1172/JCI114844
[33] J. Beige, S. Scherer, A. Weber, S. Engeli, G. Offermann, G. Opelz, A. Distle and A. M. Sharma, “Angiotensin-Converting Enzyme Genotype and Renal Allograft Survival,” Journal of the American Society of Nephrology, Vol. 8, No. 8, 1997, pp. 1319-1323.
[34] J. Broekroelofs, C. A. Stegeman, G. Navis, A. M. Tegzess, Z. D. De and P. E. De Jong, “Risk Factors for Long-Term Renal Survival after Renal Transplantation: A Role for Angiotensin-Converting Enzyme (Insertion/Deletion) Polymorphism?” Journal of the American Society of Nephrology, Vol. 9, No. 11, 1998, pp. 2075-2081.
[35] S. Barocci, F. Ginevri, U. Valente, F. Torre, R. Gusmano and A. Nocera, “Correlation between Angiotensin-Converting Enzyme Gene Insertion/Deletion Polymorphism and Kidney Graft Long-Term Outcome in Pediatric Recipients: A Single-Center Analysis,” Transplantation, Vol. 67, No. 4, 1999, pp. 534-538. doi:10.1097/00007890-199902270-00008
[36] M. B. Juckett, E. P. Cohen, C. A. Keever-Taylor, Y. Zheng, C. A. Lawton, J. E. Moulder and J. Klein, “Loss of Renal Function Following Bone Marrow Transplantation: An Analysis of Angiotensin Converting Enzyme D/I Polymorphism and Other Clinical Risk Factors,” Bone Marrow Transplant, Vol. 27, No. 4, 2001, pp. 451-456. doi:10.1038/sj.bmt.1702797
[37] R. Abdi, T. B. Tran, R. Zee, B. M. Brenner and E. L. Milford, “Angiotensin Gene Polymorphism as a Determinant of Post-Transplantation Renal Dysfunction and Hypertension,” Transplantation, Vol. 72, No. 4, 2001, pp. 726-729. doi:10.1097/00007890-200108270-00028
[38] A. O. Ojo, P. J. Held, F. K. Port, R. A. Wolfe, A. B. Leichtman, E. W. Young, et al., “Chronic Renal Failure after Transplantation of Non-Renal Organ,” New England Journal of Medicine, Vol. 349, 2003, pp. 931-940. doi:10.1056/NEJMoa021744
[39] B. M. Murray, M. S. Paller and T. F. Ferris, “Effect of Cyclosporine Administration on Renal Hemodynamics in Conscious Rats,” Kidney International, Vol. 28, 1985, pp. 767-774. doi:10.1038/ki.1985.196
[40] E. J. G. Barros, M. A. Boim and H. Ajzen, “Glomerular Hemodynamics and Hormonal Participation on Cyclosporine Nephrotoxicity,” Kidney International, Vol. 32, 1987, pp. 19-25. doi:10.1038/ki.1987.166
[41] S. C. Textor, J. C. Burnett, J. C. Romero Jr., V. J. Canzanello, S. J. Taler, R. Wiesner, et al., “Urinary Endothelin and Renal Vasoconstriction with Cyclosporine or FK506 after Liver Transplantation,” Kidney International, Vol. 47, 1995, pp. 1426-1433. doi:10.1038/ki.1995.200
[42] S. Hortelano, M. Castilla, A. M. Torres, A. Tejedor and L. Bosc′a, “Potentiation by Nitric Oxide of Cyclosporin A and FK506-Induced Apoptosis in Renal Proximal Tubule Cells,” Journal of the American Society of Nephrology, Vol. 11, No. 12, 2000, pp. 2315-2323.
[43] A. Kurtz, R. Della Bruna and K. Kuhn, “Cyclosporine A Enhances Renin Secretion and Production in Isolated Juxtaglomerular Cells,” Kidney International, Vol. 33, 1988, pp. 947-953. doi:10.1038/ki.1988.92
[44] K. Hoecherl, F. Dreher, H. Vitzthum, J. Koehler and A. Kurtz, “Cyclosporin A Suppresses Cyclooxygenase-2 Expression in the Rat Kidney,” Journal of the American Society of Nephrology, Vol. 13, No. 10, 2002, pp. 2427-2436. doi:10.1097/01.ASN.0000031702.86799.B9
[45] S. W. Lim, C. Li, K. O. Ahn, et al., “Cyclosporine-Induced Renal Injury Induces Toll-Like Receptor and Maturation of Dendritic Cells,” Transplantation, Vol. 80, No. 5, 2005, pp. 691-699. doi:10.1097/01.tp.0000173594.69089.a0
[46] W. M. Bennet, A. De Mattos, M. M. Meyer, T. Andoh and J. M. Barry, “Chronic Cyclosporine Nephropathy: The Achilles’ Heel of Immunosuppressive Therapy,” Kidney International, Vol. 50, 1996, pp. 1089-1100. doi:10.1038/ki.1996.415
[47] B. D. Myers, J. Ross and L. Newton, “Cyclosporine-Associated Chronic Nephropathy,” New England Journal of Medicine, Vol. 311, No. 11, 1984, pp. 699-705.
[48] M. E. Falkenhain, F. G. Cosio and D. D. Sedmak, “Progressive Histologic Injury in Kidneys from Heart and Liver Transplant Recipients Receiving Cyclosporine,” Transplantation, Vol. 62, No. 3, 1996, pp. 364-370. doi:10.1097/00007890-199608150-00011
[49] J. S. Zaltzman, Y. Pei, J. Maurer, A. Patterson and D. C. Cattran, “Cyclosporine Nephrotoxicity in Lung Transplant Recipients,” Transplantation, Vol. 54, No. 5, 1992, pp. 875-878. doi:10.1097/00007890-199211000-00021
[50] S. Sandrini, G. Setti, N. Bossini, R. Zubani, S. Cassamali, P. Maiorca, et al., “Experience with Cyclosporine,” Transplant Proceedings, Vol. 36, Suppl. 2S, 2004, pp. 152S-157S. doi:10.1016/j.transproceed.2003.12.036
[51] D. Diederich, J. Skopec, A. Diederich and F.-X. Dai, “Cyclosporine Produces Endothelial Dysfunction by Increased Production of Superoxide,” Hypertension, Vol. 23, 1994, pp. 957-961. doi:10.1161/01.HYP.23.6.957
[52] R. Christiane and W. Gunter, “Renin-Angiotensin-Aldosterone System and Progression of Renal Disease,” Journal of the American Society of Nephrology, Vol. 17, No. 11, 2006, pp. 2985-2991. doi:10.1681/ASN.2006040356
[53] G. Wolf, “Renal Injury Due to Renin-Angiotensin-Aldosterone System Activation of the Transforming Growth Factor-β Pathway,” Kidney International, Vol. 70, No. 11, 2006, pp. 1914-1919.
[54] B. J. Nankivell, R. J. Borrows, C. L. S. Fung, P. J. O’Connell, J. R. Chapman and R. D. M. Allen, “Calcineurin Inhibitor Nephrotoxicity: Longitudinal Assessment by Protocol Histology,” Transplantation, Vol. 78, No. 4, 2004, pp. 557-565. doi:10.1097/01.TP.0000128636.70499.6E
[55] E. M. Johnson, D. M. Canafax, K. J. Gillingham, A. Humar, K. Pandian, S. R. Kerr, et al., “Effect of Early Cyclosporine Levels on Kidney Allograft Rejection,” Clinical Transplantation, Vol. 11, No. 6, 1997, pp. 552-557.
[56] N. Kambham, S. Nagarajan, S. Shah, L. Li, O. Salvatierra and M. M. Sarwal, “A Novel, Semiquantitative, Clinically Correlated Calcineurin Inhibitor Toxicity Score for Renal Allograft Biopsies,” Clinical Journal of the American Society of Nephrology, Vol. 2, No. 1, 2007, pp. 135-142. doi:10.2215/CJN.01320406
[57] A. Greenberg, J. W. Egel, M. E. Thompson, R. L. Hardesty, B. P. Griffith, H. T. Bahnson, et al., “Early and Late Forms of Cyclosporine Nephrotoxicity: Studies in Cardiac Transplant Recipients,” American Journal of Kidney Diseases, Vol. 9, No. 1, 1987, pp. 12-22.
[58] P. F. Hoyer, G. Offner, K. Wonigeit, J. Brodehl and R. Pichelmayr, “Dosage of Cyclosporin A in Children with Renal Transplant,” Clinical Nephrology, Vol. 22, No. 2, 1984, pp. 68-71.
[59] H. Zachariae, K. Kragballe, H. E. Hansen, N. Marcussen and S. Olsen, “Renal Biopsy Findings in Long-Term Cyclosporin Treatment of Psoriasis,” The British Journal of Dermatology, Vol. 136, No. 4, 1997, pp. 531-535.
[60] N. J. Lowe, J. M. Wieder, A. Rosenbach, K. Johnson, R. Kunkel, C. Bainbridge, et al., “Long-Term Low-Dose Cyclosporine Therapy for Severe Psoriasis: Effects on Renal Function and Structure,” Journal of the American Academy of Dermatology, Vol. 35, No. 5, 1996, pp. 710-719. doi:10.1016/S0190-9622(96)90726-4
[61] J. M. Messana, K. J. Johnson and M. J. Mihatsch, “Renal Structure and Function Effects after Low Dose Cyclosporine in Psoriasis Patients: A Preliminary Report,” Clinical Nephrology, Vol. 43, No. 3, 1995, pp. 150-153.
[62] E. W. Young, C. N. Ellis, J. M. Messana, K. J. Johnson, A. B. Leichtman, M. J. Mihatsch, et al., “A Prospective Study of Renal Structure and Function in Psoriasis Patients Treated with Cyclosporine,” Kidney International, Vol. 46, 1994, pp. 1216-1222. doi:10.1038/ki.1994.387
[63] E. Svarstad, S. Helland, T. Morken, L. Bostad, A. Myking, B. M. Iversen and J. Ofstad, “Renal Effects of Maintenance Low-Dose Cyclosporin A Treatment in Psoriasis,” Nephrology, Dialysis, Transplantation, Vol. 9, No. 10, 1994, pp. 1462-1467.
[64] Y. Pei, J. W. Scholey, A. Katz, R. Schachter, G. F. Murphy and D. Cattran, “Chronic Nephrotoxicity in Psoriatic Patients Treated with Low-Dose Cyclosporine,” American Journal of Kidney Diseases, Vol. 23, No. 4, 1994, pp. 528-536.
[65] A. V. Powles, T. Cook, B. Hulme, B. S. Baker, H. M. Lewis, E. Thomas, et al., “Renal Function and Biopsy Findings after 5 Years’ Treatment with Low-Dose Cyclosporin for Psoriasis,” The British Journal of Dermatology, Vol. 128, No. 2, 1993, pp. 159-165. doi:10.1111/j.1365-2133.1993.tb15145.x
[66] A. V. Powles, C. M. Hardman, W. M. Porter, T. Cook, B. Hulme and L. Fry, “Renal Function after 10 Years’ Treatment with Cyclosporin for Psoriasis,” The British Journal of Dermatology, Vol. 138, No. 3, 1998, pp. 443-439. doi:10.1046/j.1365-2133.1998.02122.x
[67] H. Zachariae, H. E. Hansen, K. Kragballe and S. Olsen, “Morphologic Renal Changes during Cyclosporine Treatment of Psoriasis. Studies on Pretreatment and PostTreatment Kidney Biopsy Specimens,” Journal of the American Academy of Dermatology, Vol. 26, No. 3, 1992, pp. 415-419.
[68] M. J. Mihatsch, G. Thiel and B. Ryffel, “Morphology of Cyclosporine Nephropathy,” Progress in Allergy, Vol. 38, 1986, pp. 447-465.
[69] U. Mrowietz, L. Faerber, H. H. Henneicke-von Zepelin, H. Bachmann, D. Welzel and E. Christophers, “Long-Term Maintenance Therapy with Cyclosporine and Post-Treatment Survey in Severe Psoriasis: Results of a Multicenter Study. German Multicenter Study,” Journal of the American Academy of Dermatology, Vol. 33, No. 3, 1995, pp. 470-475.
[70] C. Laburte, R. Grossman, J. Abi-Rached, K. H. Abeywickrama and L. Dubertret, “Efficacy and Safety of Oral Cyclosporin A (CyA; Sandimmun) for Long-Term Treatment of Chronic Severe Plaque Psoriasis,” British Journal of Dermatology, Vol. 130, No. 3, 1994, pp. 366-375. doi:10.1111/j.1365-2133.1994.tb02935.x
[71] J. Shupack, E. Abel, E. Bauer, M. Brown, L. Drake, R. Freinkel, et al., “Cyclosporine as Maintenance Therapy in Patients with Severe Psoriasis,” Journal of the American Academy of Dermatology, Vol. 36, No. 3, 1997, pp. 423-432.
[72] V. C. Ho, C. E. Griffiths, G. Albrecht, F. Vanaclocha, G. León-Dorantes, N. Atakan, et al., “Intermittent Short Courses of Cyclosporin (NeoralR) for Psoriasis Unresponsive to Topical Therapy: A 1-Year Multicentre, Randomized Study. The PISCES Study Group,” British Journal of Dermatology, Vol. 141, No. 2, 1999, pp. 283-291. doi:10.1046/j.1365-2133.1999.02977.x
[73] P. Gisondi, M. Del Giglio, V. Di Francesco, et al., “Weight Loss Improves the Response of Obese Patients with Moderate-to-Severe Chronic Plaque Psoriasis to Low-Dose Cyclosporine Therapy: A Randomized, Controlled, Investigator-Blinded Clinical Trial,” The American Journal of Clinical Nutrition, Vol. 88, No. 5, 2008, pp. 1242-1247.
[74] J. F. Honeyman, L. Sànchez and P. Valdés, “Low-Dose Cyclosporine A Improves Severe Disabling Psoriasis in Latin America. Latin American Multicenter Study,” International Journal of Dermatology, Vol. 34, No. 8, 1995, pp. 583-588. doi:10.1111/j.1365-4362.1995.tb02961.x
[75] G. S. Panayi and P. Tugwell, “An International Consensus Report: The Use of Cyclosporin A in Rheumatoid Arthritis,” British Journal of Rheumatology, Vol. 32, Suppl. 1, 1993, pp. 1-3.
[76] G. S. Panayi and P. Tugwell, “The Use of Cyclosporin A in Rheumatoid Arthritis: Conclusions of an International Review,” British Journal of Rheumatology, Vol. 33, No. 10, 1994, pp. 967-969. doi:10.1093/rheumatology/33.10.967
[77] R. Assan, F. Blanchet, G. Feutren, J. Timsit, E. Larger, C. Boitard, et al., “Normal Renal Function 8 to 13 Years after Cyclosporin A Therapy in 285 Diabetic Patients,” Diabetes/Metabolism Research and Reviews, Vol. 18, No. 6, 2002, pp. 464-472. doi:10.1002/dmrr.325
[78] H. Ekberg, H. Tedesco-Silva, A. Demirbas, S. Vitko, B. Nashan, A. Gurkan, et al., “Reduced Exposure to Calcineurin Inhibitors in Renal Transplantation,” New England Journal of Medicine, Vol. 357, 2007, pp. 2562-2575. doi:10.1056/NEJMoa067411
[79] H. Ekberg, J. Grinyo, B. Nashan, Y. Vanrenterghem, F. Vincenti, A. Voulgari, et al., “Cyclosporine Sparing with Mycophenolate Mofetil, Daclizumab and Corticosteroids in Renal Allograft Recipients: The CAESAR Study,” American Journal of Transplantation, Vol. 7, No. 3, 2007, pp. 560-570. doi:10.1111/j.1600-6143.2006.01645.x
[80] T. R. Srinivas and H. U. Meier-Kriesche, “Minimizing Immunosuppression, an Alternative Approach to Reducing Side Effects: Objectives and Interim Result,” Clinical Journal of the American Society Nephrology, Vol. 3, Suppl. 2, 2008, pp. S101-S116. doi:10.2215/CJN.03510807
[81] S. M. Flechner, J. Kobashigawa and G. Klintmalm, “Calcineurin Inhibitor-Sparing Regimens in Solid Organ Transplantation: Focus on Improving Renal Function and Nephrotoxicity,” Clinical Transplantation, Vol. 22, No. 1, 2008, pp. 1-15.
[82] D. Colombo, N. Cassano, G. Altomare, A. Giannetti and G. A. Vena, “Psoriasis Relapse Evaluation with Week-End Cyclosporine A Treatment: Results of a Randomized, Double-Blind, Multicenter Study,” International Journal of Immunopathology and Pharmacology, Vol. 23, No. 4, 2010, pp. 1143-1152.
[83] P. Ruggenenti, N. Perico, L. Mosconi, F. Gaspari, A. Benigni, C. S. Amuchastegui, et al., “Calcium Channel Blockers Protect Transplant Patients from Cyclosporine-Induced Daily Renal Hypoperfusion,” Kidney International, Vol. 43, 1993, pp. 706-711. doi:10.1038/ki.1993.101
[84] K. H. Rahn, M. Barenbrock, F. Fritschka, A. Heinecke, J. Lippert, K. Schroeder, et al., “Effect of Nitrendipine on Renal Function in Renal-Transplant Patients Treated with Cyclosporin: A Randomised Trial,” The Lancet, Vol. 354, No. 9188, 1999, pp. 1415-1420. doi:10.1016/S0140-6736(99)08421-4
[85] B. J. Nankivell, J. R. Chapman, G. Bonovas and S. Gruenewals, “Oral Cyclosporine But Not Tacrolimus Reduces Renal Transplant Blood Flow,” Transplantation, Vol. 77, No. 9, 2004, pp. 1457-1459. doi:10.1097/01.TP.0000121196.71904.E0
[86] J. M. Morales, E. Rodriguez-Paternina, A. Araque, A. Andres, E. Hernandez, L. M. Ruilope and J. L. Rodicio, “Long-Term Protective Effect of a Calcium Antagonist on Renal Function in Hypertensive Renal Transplant Patients on Cyclosporine Therapy: A 5-Year Prospective Randomized Study,” Transplant Proceedings, Vol. 26, No. 5, 1994, pp. 2598-2599.
[87] D. R. Kuypers, H. H. Neumayer, L. Fritsche, K. Budde, J. Rodicio, Y. Vanrenterghem (Lacidipine Study Group), “Calcium Channel Blockade and Preservation of Renal Graft Function in Cyclosporine-Treated Recipients: A Prospective Randomized Placebo-Controlled 2-Year Study,” Transplantation, Vol. 78, No. 8, 2004, pp. 1204-1211. doi:10.1097/01.TP.0000137793.23371.42
[88] L. Legault, R. I. Ogilvie, C. J. Cardella and F. H. Leenen, “Calcium Antagonists in Heart Transplant Recipients: Effects on Cardiac and Renal Function and Cyclosporine Pharmacokinetics,” The Canadian Journal of Cardiology, Vol. 9, No. 5, 1993, pp. 398-404.
[89] F. H. Leenen, E. Coletta and R. A. Davies, “Prevention of Renal Dysfunction and Hypertension by Amlodipine after Heart Transplant,” American Journal of Cardiology, Vol. 100, No. 3, 2007, pp. 531-535. doi:10.1016/j.amjcard.2007.03.058
[90] B. Lindelow, C. H. Bergh, H. Herlitz and F. Waagstein, “Predictors and Evolution of Renal Function during 9 Years Following Heart Transplantation,” Journal of the American Society of Nephrology, Vol. 11, No. 5, 2000, pp. 951-957.
[91] T. P. Hannedouche, S. Natov, C. Boitard, B. Lacour and J. P. Grunfeld, “Angiotensin Converting Enzyme Inhibition and Chronic Cyclosporine-Induced Renal Dysfunction in Type 1 Diabetes,” Nephrology Dialysis Transplantation, Vol. 11, No. 4, 1996, pp. 673-678. doi:10.1093/oxfordjournals.ndt.a027358
[92] M. Hausberg, M. Kosch, H. Hohage, B. Suwelack, M. Barenbrock, K. Kisters and K. H. Rahn, “Antihypertensive Treatment in Renal Transplant Patients—Is There a Role for ACE Inhibitors?” Annals of Transplantation, Vol. 6, No. 4, 2001, pp. 31-37.
[93] J. M. Campistol, P. Inigo, W. Jimenez, S. Lario, P. H. Clesca, F. Oppenheimer and F. Rivera, “Losartan Decreases Plasma Levels of TGF-Beta1 in Transplant Patients with Chronic Allograft Nephropathy,” Kidney International, Vol. 56, 1999, pp. 714-719. doi:10.1046/j.1523-1755.1999.00597.x
[94] P. Inigo, J. M. Campistol, S. Lario, C. Piera, B. Campos, M. Bescos, et al., “Effects of Losartan and Amlodipine on Intrarenal Hemodynamics and TGF-Beta(1) Plasma Levels in a Crossover Trial in Renal Transplant Recipients,” Journal of the American Society of Nephrology, Vol. 12, No. 4, 2001, pp. 822-827.
[95] G. Mourad, J. Ribstein and A. Mimran, “Converting-Enzyme Inhibitor Versus Calcium Antagonist in Cyclosporine-Treated Renal Transplants,” Kidney International, Vol. 43, 1993, pp. 419-425. doi:10.1038/ki.1993.61
[96] K. Midtvedt, A. Hartmann, A. Foss, P. Fauchald, K. P. Nordal, K. Rootwelt and H. Holdaas, “Sustained Improvement of Renal Graft Function for Two Years in Hypertensive Renal Transplant Recipients Treated with Nifedipine as Compared to Lisinopril,” Transplantation, Vol. 72, No. 11, 2001, pp. 1787-1792. doi:10.1097/00007890-200112150-00013
[97] M. Moran, M. F. Mozes, M. Maddux, S. Veremis, C. Bartkus, B. Ketel, et al., “Prevention of Acute Graft Rejection by the Prostaglandin E1 Analogue Misoprostol in Renal-Transplant Recipients Treated with Cyclosporine and Prednisone,” New England Journal of Medicine, Vol. 322, 1990, pp. 1183-1188. doi:10.1056/NEJM199004263221703
[98] M. Boers, W. G. Bensen, D. Ludwin, C. H. Goldsmith and P. Tugwell, “Cyclosporine Nephrotoxicity in Rheumatoid Arthritis: No Effect of Short Term Misoprostol Treatment,” The Journal of Rheumatology, Vol. 19, No. 4, 1992, pp. 534-537.
[99] X. Z. Zhang, G. Ardissino, L. Ghio, A. S. Tirelli, V. Dacco, D, Colombo, et al., “L-Arginine Supplementation in Young Renal Allograft Recipients with Chronic Transplant Dysfunction,” Clinical Nephrology, Vol. 55, No. 6, 2001, pp. 453-439.
[100] H. Ling, X. Li, S. Jha, W. Wan, L. Karetskaya, B. Pratt and S. Ledbetter, “Therapeutic Role of TGF-Beta-Neutralizing Antibody in Mouse Cyclosporin A Nephropathy: Morphologic Improvement Associated with Functional Preservation,” Journal of the American Society of Nephrology, Vol. 14, No. 2, 2003, 377-388. doi:10.1097/01.ASN.0000042168.43665.9B
[101] M. Islam, J. F. Burke Jr., T. A. McGowan, Y. Zhu, S. R. Dunn, P. McCue, et al., “Effect of Anti-Transforming Growth Factor-Beta Antibodies in Cyclosporine-Induced Renal Dysfunction,” Kidney International, Vol. 59, 2001, pp. 498-506. doi:10.1046/j.1523-1755.2001.059002498.x
[102] M. Tariq, C. Morais, S. Sobki, M. Al Sulaiman and A. Al Khader, “N-Acetylcysteine Attenuates Cyclosporin-Induced Nephrotoxicity in Rats,” Nephrology Dialysis Transplantation, Vol. 14, No. 4, 1999, pp. 923-929. doi:10.1093/ndt/14.4.923
[103] P. Barany, P. Stenvinkel, A. Ottosson-Seeberger, A. Alvestrand, J. Morrow, J. J. Roberts and A. K. Salahudeen, “Effect of 6 Weeks of Vitamin E Administration on Renal Haemodynamic Alterations Following a Single Dose of Neoral in Healthy Volunteers,” Nephrology Dialysis Transplantation, Vol. 16, No. 3, 2001, pp. 580-584. doi:10.1093/ndt/16.3.580
[104] J. K. Jenkins, H. Huang, K. Ndebele and A. K. Salahudeen, “Vitamin E Inhibits Renal mRNA Expression of COX II, HO I, TGF-Beta, and Osteopontin in the Rat Model of Cyclosporine Nephrotoxicity,” Transplantation, Vol. 71, No. 2, 2001, pp. 331-334. doi:10.1097/00007890-200101270-00028
[105] C. Lessio, S. F. de Assuncao, M. A. Gloria, A. B. Di Tommaso, M. M. Gori, G. S. Di Marco, et al., “Cyclosporine A and NAC on the Inducible Nitric Oxide Synthase Expression and Nitric Oxide Synthesis in Rat Renal Artery Cultured Cells,” Kidney International, Vol. 68, 2005, pp. 2508-2516. doi:10.1111/j.1523-1755.2005.00726.x
[106] C. Li, B. K. Sun, S. W. Lim, J. C. Song, S. W. Kang, Y. S. Kim, et al., “Combined Effects of Losartan and Pravastatin on Interstitial Inflammation and Fibrosis in Chronic Cyclosporine-Induced Nephropathy,” Transplantation, Vol. 79, No. 11, 2005, pp. 1522-1529.
[107] A. K. Pere, L. Lindgren, P. Tuomainen, L. Krogerus, P. Rauhala, J. Laakso, et al., “Dietary Potassium and Magnesium Supplementation in Cyclosporine-Induced Hypertension and Nephrotoxicity,” Kidney International, Vol. 58, 2000, pp. 2462-2472. doi:10.1046/j.1523-1755.2000.00429.x
[108] T. Asai, T. Nakatani, S. Tamada, N. Kuwabara, S. Yamanaka, K. Tashiro, et al., “Activation of Transcription Factors AP-1 and NF-kappaB in Chronic Cyclosporine A Nephrotoxicity: Role in Beneficial Effects of Magnesium Supplementation,” Transplantation, Vol. 75, No. 7, 2003, pp. 1040-1044. doi:10.1097/01.TP.0000057242.96219.AF
[109] M. J. Mihatsch, D. Belghiti and S. O. Bohman, “Kidney Biopsies in Control of Cyclosporine A Treated Psoriatic Patients,” British Journal of Dermatology, Vol. 122, Suppl. 22, 1990, pp. 95-100. doi:10.1111/j.1365-2133.1990.tb02887.x
[110] L. Faerber, M. Braeutigam, G. Weidinger, U. Mrowietz, E. Christophers, H. J. Schulze, et al., “Cyclosporine in Severe Psoriasis: Results of a Meta-Analysis,” American Journal of Clinical Dermatology, Vol. 2, No. 1, 2001, pp. 41-47. doi:10.2165/00128071-200102010-00007
[111] J. Berth-Jones, C. A. Henderson, C. S. Munro, S. Rogers, R. J. Chalmers, M. J. Boffa, et al., “Treatment of Psoriasis with Intermittent Short-Course Cyclosporine (Neoral®). A Multicentre Study,” British Journal of Dermatology, Vol. 136, No. 4, 1997, pp. 527-530.
[112] V. C. Y. Ho, C. E. M. Griffiths, J. Berth-Jones, K. A. Papp, F. Vanaclocha, E. Dauden, et al., “Intermittent Short Courses of Cyclosporine Microemulsion for the Long-Term Management of Psoriasis: A 2-Year Cohort Study,” Journal of the American Academy of Dermatology, Vol. 44, No. 4, 2001, pp. 643-651. doi:10.1067/mjd.2001.112400
[113] D. Pathirana, A. D. Ormerod, P. Saiag, C. Smith, P. I. Spuls, A. Nast, et al., “European S3-Guidelines on the Systemic Treatment of Psoriasis Vulgaris,” Journal of the European Academy of Dermatology and Venereology, Vol. 23, No. 2, 2009, pp. 1-70. doi:10.1111/j.1468-3083.2009.03389.x
[114] G. Feutren, K. Abeywickrama, D. Friend and B. Von Graffenried, “Renal Function and Blood Pressure in Psoriatic Patients Treated with Cyclosporine A,” British Journal of Dermatology, Vol. 122, No. 36, 1990, pp. 57-69. doi:10.1111/j.1365-2133.1990.tb02883.x
[115] H. I. Katz, “Potential Drug Interactions with Cyclosporine,” International Journal of Dermatology, Vol. 36, No. 1, 1997, pp. 18-24. doi:10.1046/j.1365-4362.36.s1.5.x

  
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