Can maintenance cyclosporine be used in psoriasis without decreasing renal function?

Nephrotoxicity attributable to cyclosporine therapy is dose dependent and unlikely to occur in psoriasis treatment protocols using less than 5 mg/kg/d in otherwise healthy patients. Any long-term or maintenance protocol should include regular monitoring of urea nitrogen/creatinine levels and blood pressure. Cyclosporine is a potent drug, and it is reasonable to monitor its administration to otherwise healthy psoriasis patients with yearly measurement of glomerular filtration rate (GFR), especially in elderly patients or patients with diminished renal reserve (eg, diabetes). There is no convincing evidence of irreversible renal dysfunction in psoriasis patients on low-dose cyclosporine protocols, nor is there evidence that cyclosporine in low doses in completely safe or banal. Therefore, we suggest monitoring GFR at 3, 6, and 12 months after initiating therapy, provided serum creatinine level is stable. If serum creatinine level increases by > 30% over baseline, GFR should be monitored more frequently and the dose of cyclosporine adjusted if there is a persistent decrease.