CYCLOSPORINE-ASSOCIATED CHRONIC NEPHROPATHY
CYCLOSPORINE-ASSOCIATED CHRONIC NEPHROPATHY
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DOI：
10.1056/nejm198409133111103
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发表时间：
1984-01-01
影响因子：
158.5
通讯作者：
PERLROTH, M
中科院分区：
文献类型：
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作者：
MYERS, BD;ROSS, J;PERLROTH, M
17例心脏移植受者治疗12个月后的肾小球滤过率。或更长时间的环孢菌素（环孢菌素A）进行评价。对照组由15名接受硫唑嘌呤治疗的心脏移植受者组成，他们也存活了至少12个月。尽管心输出量相当，但肾小球滤过率降低（51 . ±. 4对93 +-。3 ml/min，P < 0.005。环孢霉素治疗也与肾血浆流量减少有关（320 ± 0.01）。21对480 +-。30 ml/min，P < 0.001）。环孢霉素治疗受者中性葡聚糖（半径，2.4-5.8 nm）的限制性跨肾小球转运的趋势表明肾小球毛细血管超滤能力的内在损失，而不是肾小球滤过率降低的血流动力学基础。5例环孢素治疗的肾小球低滤过患者的肾脏组织学检查显示不同程度的肾小管间质损伤伴局灶性肾小球硬化。在32例接受心脏移植治疗超过12个月的患者中，环孢霉素治疗后，2例发生终末期肾功能衰竭。长期环孢素治疗可能导致不可逆的和潜在的进展性肾病。在找到减轻其肾毒性的方法之前，应限制和谨慎使用环孢素。
Glomerular filtration in 17 recipients of heart transplants who were treated for 12 mo. or longer with cyclosporine (cyclosporin A) was evaluated. The control group consisted of 15 heart-transplant recipients who were treated with azathioprine and who had also survived for at least 12 mo. Despite an equivalent cardiac output, the glomerular filtration rate was depressed (51 .+-. 4 vs. 93 .+-. 3 ml/min, P < 0.005) in transplant recipients treated with cyclosporine. Cyclosporine treatment was also associated with reduced renal plasma flow (320 .+-. 21 vs. 480 .+-. 30 ml/min, P < 0.001). A trend toward restricted transglomerular transport of neutral dextrans (radii, 2.4-5.8 nm) in cyclosporine-treated recipients suggested an intrinsic loss of ultrafiltration capacity by glomerular capillaries rather than a hemodynamic basis for the reduced glomerular filtration rate. Histopathologic examination of the kidneys of 5 cyclosporine-treated patients with glomerular hypofiltration revealed a variable degree of tubulointerstitial injury accompanied by focal glomerular sclerosis. Among the 32 heart-transplant recipients treated for more than 12 mo. with cyclosporine, end-stage renal failure developed in 2. Long-term cyclosporine therapy may lead to irreversible and potentially progressive nephropathy. Cyclosporine should be used with restraint and caution until ways are found to mitigate its nephrotoxicity.