CHRONIC CYCLOSPORINE NEPHROTOXICITY

Cyclosporine has improved patient and graft survival rates in solid or gan transplantation, and has been increasingly applied with considerab le clinical benefit in the treatment of autoimmune diseases. However, the therapeutic benefits of immunosuppressive therapy for transplant a nd autoimmune indications have frequently been limited by the occurren ce of chronic nephrotoxicity. Cyclosporine nephrotoxicity therefore re mains an important clinical challenge. The clinical aspects and pathop hysiology of chronic cyclosporine nephrotoxicity, which is characteriz ed by a decrease in glomerular filtration rate, afferent arteriolopath y, and striped tubulointerstitial fibrosis, are reviewed. Insights gai ned from experimental models of chronic nephrotoxicity associated with tubulointerstitial fibrosis are presented to elucidate the pathophysi ology. (C) 1998 Rapid Science Ltd.