Zachariae H, Kragballe K, Hansen H E, Marcussen N, Olsen S
Arhus Universiteshospitaler, Marselisborg Hospital, dermatologisk afdeling.
Ugeskr Laeger. 1998 Jul 27;160(31):4534-8.
Renal biopsies were performed in 30 psoriatics during long-term low-dose cyclosporin (CSA) therapy (range 2.5-6 mg/kg/day) of from six months to eight years. The study included pretreatment biopsies in 25 of the patients. After two years all biopsies shared features consistent with CSA nephropathy despite completely normal pretreatment morphology in 18 of the 25 patients. The severity of the findings, which consisted of arteriolar hyalinosis, focal interstitial fibrosis and sclerotic glomeruli, increased with length of therapy. Mild renal lesions were seen during the first two years. After four years all but one had arteriolar hyalinosis, with interstitial fibrosis pronounced in five and moderate in six of 11 patients. At the same time glomerular sclerosis had become significant. A decrease in glomerular filtration rate (GFR) correlated with the severity of the fibrosis. GFR studied in 14 patients six months to seven years after discontinuation of CSA was still significantly decreased in relation to baseline prior to therapy. The data from our study together with experiences from cardiac-transplanted patients indicate that patients with psoriasis, after two years therapy with CSA, should be rotated to other treatments or be followed carefully by GFR and sequential renal biopsies.
对30例银屑病患者在长期低剂量环孢素（CSA）治疗（剂量范围为2.5 - 6毫克/千克/天）6个月至8年期间进行了肾活检。该研究纳入了25例患者的治疗前活检。两年后，尽管25例患者中有18例治疗前形态完全正常，但所有活检均显示出与CSA肾病相符的特征。包括小动脉玻璃样变性、局灶性间质纤维化和肾小球硬化在内的病变严重程度随治疗时间延长而增加。在治疗的前两年可见轻度肾脏病变。四年后，除1例患者外，所有患者均出现小动脉玻璃样变性，11例患者中有5例间质纤维化明显，6例中度。与此同时，肾小球硬化变得显著。肾小球滤过率（GFR）的降低与纤维化的严重程度相关。在停用CSA 6个月至7年后对14例患者进行研究，其GFR仍较治疗前基线水平显著降低。我们的研究数据以及心脏移植患者的经验表明，银屑病患者在接受CSA治疗两年后，应更换为其他治疗方法，或通过GFR和连续肾活检进行密切随访。
