Dieterle A, Gratwohl A, Nizze H, Huser B, Mihatsch M J, Thiel G, Tichelli A, Signer E, Nissen C, Speck B
Department of Internal Medicine, Kantonsspital, Basel, Switzerland.
Transplantation. 1990 Jun;49(6):1093-100. doi: 10.1097/00007890-199006000-00013.
This study describes the prevalence and degree of chronic cyclosporine-associated nephropathy and its risk factors. For this purpose we reviewed all available renal histology specimens in 169 bone marrow transplant recipients treated during an eight year period with cyclosporine for prevention of graft-versus-host-disease, and determined their pattern and degree of histomorphological changes. A total of 51 specimens obtained from 49 patients by biopsy (n = 12) or autopsy (n = 39) was evaluated. The pattern of histomorphological changes was compared with diagnosis, age, sex, and potential risk factors--such as cyclosporine dose, levels, duration of therapy, changes in serum creatinine and onset of hypertension. Morphological lesions of chronic cyclosporine-associated nephropathy were found in 67% of the specimens. They were more frequent and more severe with increasing duration of cyclosporine therapy, in patients with a higher increase in serum creatinine during the first 3 months and in patients given total-body irradiation for conditioning. These latter findings suggest that additional damage sensitizes the kidney to irreversible toxic effects of cyclosporine.
本研究描述了慢性环孢素相关肾病的患病率、程度及其危险因素。为此，我们回顾了169例在8年期间接受环孢素治疗以预防移植物抗宿主病的骨髓移植受者所有可用的肾脏组织学标本，并确定了其组织形态学变化的模式和程度。对通过活检（n = 12）或尸检（n = 39）从49例患者中获得的总共51份标本进行了评估。将组织形态学变化模式与诊断、年龄、性别及潜在危险因素（如环孢素剂量、血药浓度、治疗持续时间、血清肌酐变化及高血压发病情况）进行了比较。在67%的标本中发现了慢性环孢素相关肾病的形态学病变。在环孢素治疗持续时间延长的患者、最初3个月血清肌酐升高幅度较大的患者以及接受全身照射预处理的患者中，这些病变更常见且更严重。后一项发现表明，额外的损伤使肾脏对环孢素的不可逆毒性作用更敏感。
