Cattaneo D, Perico N, Gaspari F, Remuzzi G
Department of Medicine and Transplantation, Ospedali Riuniti di Bergamo, Mario Negri Institute for Pharmacological Research, Bergamo, Italy.
Transplant Proc. 2004 Mar;36(2 Suppl):234S-239S. doi: 10.1016/j.transproceed.2004.01.011.
Over the last 20 years cyclosporine (CsA) has improved the survival of kidney, heart, and liver transplants. However, with increasing use, evidence has accumulated that CsA therapy carries a variety of side effects, the most important being renal toxicity. CsA can lead to a wide spectrum of renal function impairments, including a marked and rapidly reversible decrease in renal hemodynamics (acute CsA nephrotoxicity), and a chronic form of renal damage that potentially progress irreversibly to end-stage renal disease (chronic CsA nephrotoxicity). All these manifestations are the consequence of the drug toxic effects on renal vessels and the tubulointerstitium. A proper diagnosis of CsA toxicity at early stages, the combination of low CsA doses with non-nephrotoxic immunosuppressants, and the development of more feasible strategies to monitor daily CsA exposure may contribute to a better CsA management, improve quality of life of transplant recipients, and prolong graft survival.
在过去20年里，环孢素（CsA）提高了肾、心脏和肝脏移植的存活率。然而，随着其使用的增加，越来越多的证据表明，环孢素治疗存在多种副作用，其中最重要的是肾毒性。环孢素可导致广泛的肾功能损害，包括肾血流动力学显著且迅速可逆的下降（急性环孢素肾毒性），以及一种慢性肾损害形式，可能会不可逆地进展为终末期肾病（慢性环孢素肾毒性）。所有这些表现都是该药物对肾血管和肾小管间质产生毒性作用的结果。早期正确诊断环孢素毒性，将低剂量环孢素与非肾毒性免疫抑制剂联合使用，以及制定更可行的策略来监测每日环孢素暴露量，可能有助于更好地管理环孢素，改善移植受者的生活质量，并延长移植物存活时间。
