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Normal renal function 8 to 13 years after Cyclosporin A therapy in 285 diabetic patients
Author(s) -
Assan Roger,
Blanchet Françoise,
Feutren Gilles,
Timsit José,
Larger Etienne,
Boitard Christian,
Amiel Claude,
Bach JeanFrançois
Publication year - 2002
Publication title -
diabetes/metabolism research and reviews
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.307
H-Index - 110
eISSN - 1520-7560
pISSN - 1520-7552
DOI - 10.1002/dmrr.325
Subject(s) - medicine , renal function , nephrotoxicity , urology , gastroenterology , kidney , diabetes mellitus , cohort , inulin , surgery , endocrinology , biochemistry , chemistry
Background Cyclosporin A (CyA) may induce acute nephrotoxicity. The question has been raised of the possible long‐term unfavorable course of CyA‐induced lesions. Advantage was taken of a large cohort of diabetic patients treated for several months using moderate CyA dosage to evaluate the long‐term evolution of renal function in such patients. Methods Two hundred and eighty five recently diagnosed type 1 diabetic patients having received CyA for a mean of 19.9 months were monitored for 13 years, in parallel with 100 similar patients treated with insulin alone. Results In the CyA‐treated group, a transient increase in creatininemia levels occurred during the first 18 months of treatment associated with a transient increase in renal vascular resistance. Both effects disappeared later on: creatininemia levels then remained normal. Inulin and p‐aminohippurate (PAH) clearances remained normal throughout follow‐up. Neither permanent renal failure nor progressive deterioration of renal function occurred in either group or in individual patients. A 10 to 12% increase in inulin and PAH clearance was elicited by IV amino acid infusion at 7 to 10 years, a finding consistent with a normal renal functional reserve. Patients with moderate kidney lesions on biopsy at 1 year had normal and stable clearance values at 7 to 13 years. The prevalence of arterial hypertension and retinopathy was lower in the CyA‐treated group than in the control group, possibly because of the tighter metabolic control obtained in the CyA group. Conclusion These results suggest that low‐dose CyA treatment combined with thorough monitoring does not result in long‐term renal dysfunction. Copyright © 2002 John Wiley & Sons, Ltd.