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Nephrotoxicity in bone marrow transplant recipients treated with cyclpsporin A
Author(s) -
Hows J. M.,
Chipping P. M.,
Fairhead S.,
Smith J.,
Baughan A.,
GordonSmith E. C.
Publication year - 1983
Publication title -
british journal of haematology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.907
H-Index - 186
eISSN - 1365-2141
pISSN - 0007-1048
DOI - 10.1111/j.1365-2141.1983.tb02068.x
Subject(s) - nephrotoxicity , medicine , trough level , creatinine , gastroenterology , bone marrow transplant , bone marrow , renal function , urology , transplantation , bone marrow transplantation , kidney , tacrolimus
S ummary . Cyclosporin A (CyA) is a valuable post graft immunosuppressive agent in allogeneic bone marrow transplantation. The use of CyA is associated with a reduction in severity of graft versus host disease and improved marrow engraftment. A major side effect of CyA is nephrotoxicity. In 33 patients studied during the first 4 weeks of therapy there is a close correlation between trough (12 h) serum cyclosporin A concentrations and plasma creatinine ( r =0·93, P < 0·001) and urea ( r =0·88, P < 0·001). Trough CyA serum concentrations of > 500 ng/ml are potentially nephrotoxic. Other risk factors for early nephrotoxicity in cyclosporin therapy are the concurrent use of aminoglycoside antibiotics ( P =0·01) and hyperbilirubinaemia ( P =0·01). Early nephrotoxicity can be prevented by maintaining trough CyA levels in the range 100–400 ng/ml. During prolonged CyA therapy, cumulative renal impairment can occur and nephrotoxic episodes associated with microangiopathic peripheral blood changes and hypertension are seen in a minority of patients.