Which immunosuppressants are nephrotoxic?

Abstract. The calcineurin inhibitors cyclosporin A (CsA) and tacrolimus (FK506) are associated with dose- and efficacy-limiting adverse events, including nephrotoxicity, which may diminish their overall benefits for long-term graft survival.

What does cyclosporine do to the kidneys?

The cyclosporine group demonstrated reductions in glomerular filtration rate and renal plasma flow, with higher renal vascular resistance and mean arterial pressure as compared with an azathioprine-treated control group.

Which is more nephrotoxic cyclosporine or tacrolimus?

We concluded that tacrolimus may be less nephrotoxic than cyclosporine. Tacrolimus patients showed better graft function and easier blood pressure control, but a high incidence of posttransplantation diabetes mellitus.

What drugs are nephrotoxic?

Certain drugs are inherently nephrotoxic and include aminoglycosides, amphotericin B, cisplatin, contrast dye, and cyclosporine. For others, such as those associated with chronic interstitial nephritis and crystal deposition, nephrotoxicity is dose dependant or related to prolonged duration of treatment.

Does cyclosporine cause renal failure?

Cyclosporine-induced acute renal failure, thus, appears to be due predominantly to prerenal, rather than intrarenal, processes in the experimental animal.

Is tacrolimus less nephrotoxic than cyclosporine?

There is substantial evidence that tacrolimus has a lower nephrotoxicity potential than cyclosporine. Animal studies have demonstrated that the vasoconstrictive effect of tacrolimus is weaker than of cyclosporine (205–207), and this was also confirmed in humans (208,209).

Why is tacrolimus preferred over cyclosporine?

Tacrolimus treatment is associated with a significantly better cardiovascular risk profile and superior renal function compared with cyclosporin microemulsion treatment, which appears to translate into improved long-term graft survival.

Which drugs should be stopped in AKI?

Clinicians managing patients with AKI therefore frequently stop drugs that lower blood pressure (particularly ACEI and ARBs, which selectively reduce glomerular pressure) and diuretics. ACEIs, ARBs and potassium-sparing diuretics may also be stopped because of hyperkalaemia.

Can cyclosporine cause high creatinine?

Cyclosporine may cause an increase in serum creatinine levels and may reduce the glomerular filtration rate (GFR). A creatinine target is established for each patient by calculating a number 30% above the patient’s creatinine level prior to initiating cyclosporine therapy.