Klein M, Radhakrishnan J, Appel G
Columbia University College of Physicians and Surgeons, New York, New York, USA.
Annu Rev Med. 1999;50:1-15. doi: 10.1146/annurev.med.50.1.1.
Cyclosporine-A is primary therapy for organ transplantation. Its immunosuppressive effect might suggest a therapeutic role in autoimmune diseases, including several idiopathic and secondary glomerular conditions. Various forms of idiopathic nephrotic syndrome, including focal segmental glomerulosclerosis (FSGS), minimal change disease (MCD), and membranous nephropathy (MN), may respond well to cyclosporine in selected patients. However, frequent relapse limits its use to those who have failed to respond to, or were intolerant of, steroids or cytotoxics. Cyclosporine's efficacy in other glomerulopathies, such as IgA nephropathy (IgAN) and membranoproliferative glomerulonephritis (MPGN) remains poorly studied and, given the risk of nephrotoxicity, cannot be recommended for treatment of these entities until further data are available. Cyclosporine demonstrates some efficacy in treating proliferative lupus nephritis and, based on pilot study data, membranous lupus as well. Again, given relapse rates and potential nephrotoxicity, it should be used only in combination with azathioprine and steroids, assuming cytotoxic therapy has failed. Finally, cyclosporine toxicity is briefly reviewed.
环孢素A是器官移植的主要治疗药物。其免疫抑制作用可能提示其在自身免疫性疾病（包括几种特发性和继发性肾小球疾病）中具有治疗作用。各种形式的特发性肾病综合征，包括局灶节段性肾小球硬化症（FSGS）、微小病变病（MCD）和膜性肾病（MN），在部分患者中可能对环孢素反应良好。然而，频繁复发限制了其应用于那些对类固醇或细胞毒性药物无反应或不耐受的患者。环孢素在其他肾小球疾病（如IgA肾病（IgAN）和膜增生性肾小球肾炎（MPGN））中的疗效仍研究不足，鉴于存在肾毒性风险，在获得更多数据之前，不推荐用于这些疾病的治疗。环孢素在治疗增殖性狼疮性肾炎方面显示出一定疗效，基于初步研究数据，对膜性狼疮也有疗效。同样，鉴于复发率和潜在的肾毒性，仅应在细胞毒性治疗失败的情况下，与硫唑嘌呤和类固醇联合使用。最后，简要回顾环孢素的毒性。
