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Cyclosporine versus everolimus: effects on the glomerulus
Author(s) -
Baas Marije C.,
Kers Jesper,
Florquin Sandrine,
Fijter Johan W.,
Homan van der Heide Jaap J.,
Bergh Weerman Marius A.,
ten Berge Ineke J. M.,
Bemelman Frederike J.
Publication year - 2013
Publication title -
clinical transplantation
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.918
H-Index - 76
eISSN - 1399-0012
pISSN - 0902-0063
DOI - 10.1111/ctr.12144
Subject(s) - everolimus , medicine , proteinuria , calcineurin , urology , sirolimus , immunosuppression , prednisolone , transplantation , glomerular basement membrane , kidney transplantation , renal function , kidney
Inhibitors of the mammalian target of rapamycin ( mTOR ) have been associated with proteinuria. We studied the development of proteinuria in renal transplant recipients ( RTR ) treated with the mTOR inhibitor everolimus in comparison with a calcineurin inhibitor. We related the presence of proteinuria to histopathological glomerular findings in two‐yr protocol biopsies. In a single‐center study, nested in a multicenter randomized controlled trial, we determined eGFR , proteinuria, and renal biopsy data (light‐ and electron microscopy) of RTR receiving prednisolone/everolimus ( P / EVL ) (n = 16) in comparison with patients treated with prednisolone/cyclosporine A ( P / C s A ) (n = 7). All patients had been on the above‐described maintenance immunosuppression for 18 months. Renal function at two yr after transplantation did not differ between patients receiving P / EVL or P / C s A ( eGFR 45.5 vs. 45.7 mL/min/1.73 m 2 ). Proteinuria was slightly increased in P / EVL vs. P / C s A group (0.29 vs. 0.14 g/24 h, p = 0.06). There were no differences in light‐ or electron microscopic findings. We could not demonstrate increased podocyte effacement or changes in glomerular basement membrane ( GBM ) thickness in P / EVL ‐treated patients. In conclusion, long‐term treatment with everolimus leaves the GBM and podocytes unaffected.