Cyclosporine for Kidney Disease
If immune system is too active, it will attack kidney cells after attacking foreign pathogens, and people will suffer from kidney disease, leading to protein leakage.
When the illness is not serious, we can use ACEI/ARBs to alleviate inflammation. If the illness is serious, we need to use cytotoxic drug to attack the immune system and "fierce drugs" to alleviate the kidney damage caused by excessive immune response.
What we are talking about today is a powerful drug - cyclosporine.
First of all, let’s see its side effects.
Cyclosporine has been used in kidney disease for more than 30 years since 1987. To be honest, we are not very willing to treat kidney disease with cyclosporine because of its side effects.
As everyone knows, cyclosporine, as an immunosuppressant, reduces immunity after use. Cyclosporine A can suppress the overactive immune system by reducing some cytokines in the body, thereby reducing the production of T lymphocyte.
In addition to reducing immunity and increasing risk of infection, cyclosporine also has nephrotoxicity, yes, nephrotoxicity. Nevertheless, kidney patients need not worry too much. Cyclosporine dosage is generally safe when it is less than 5 mg/kg. It should be used from a small dose until the blood concentration is stable.
Other adverse effects of cyclosporine may include hypertension, metabolic abnormalities, infections, thrombotic microangiopathy, gingival hyperplasia and gastrointestinal reactions.
Although cyclosporine has many side effects, we still need it. When confronted with refractory kidney disease and other drugs do not take effect, cyclosporine can often play a powerful role in turning the tide around.
Which kidney disease can be treated with cyclosporine?
1. Minimal change disease (MCD)
Isn't steroid enough for MCD? This is usually the case, but there are exceptions:
If the MCD patients have steroid contraindications, such as obesity, diabetes, osteoporosis, the elderly (over 70 years old), they can not use large doses of steroids.
In addition, some patients with MCD relapse frequently after steroid treatment, so they need to add immunosuppressive agents. If they still have relapse after cyclophosphamide treatment, they should consider using cyclosporine. And some MCD patients with frequent recurrence are reluctant to use cyclophosphamide, because cyclophosphamide has gonadal toxicity. Although cyclophosphamide generally does not affect fertility before the cumulative dose, there are certain risks after all, and patients who are not pregnant always have concerns in this regard.
Also, some MCD patients are reluctant to use steroids. There are many young boys and girls in the patients with MCD, just entering the age of beauty, steroid side effects such as centripetal obesity, striae gravidarum, buffalo back, acne and so on are unacceptable. Cyclosporine alone can also be considered. As long as the dosage of cyclosporine is well controlled, the side effects of steroids can be avoided while the therapeutic effect is achieved.
Steroid therapy is the first choice for patients with focal segmental glomerulosclerosis (FSGS). However, some FSGS patients can not use steroids, or can not use large doses of steroids, or often have relapse after steroid use: relapse for 2 times or more in 6 months, or recurrence for 3 times or more in 12 months. Then cyclosporine can be considered.
3. Membranous nephropathy
It is better for patients with membranous nephropathy to turn proteinuria negative. After routine treatment. Even if the urinary protein is 1-3g/24g, the effect on renal function is not as great as that of other nephropathy. But if the urinary protein is more than 4g, we should consider the combination of steroids and immunosuppressive agents. Steroid alone is ineffective for membranous nephropathy.
If patients are afraid of the side effects of cyclophosphamide and abandon it, cyclosporine: steroid + cyclosporine can be chosen to treat membranous nephropathy.
4. Other kidney disease
Cyclosporine may also be effective in the treatment of membranous proliferative nephropathy, IgA Nephropathy, mesangial proliferative nephropathy, lupus nephropathy, etc. when other drugs are inappropriate.
In short, cyclosporine is not a first-line drug for nephropathy, but a "bottom card". When other drugs can not overcome the disease, cyclosporine may help us turn the tables upside down.
Cautions for the use of cyclosporine
1. Medicine-taking time. The blood concentration of cyclosporine is affected by food. The time of taking the drug and eating meal should not be too close. It should be taken after 2 hours of meal or before 1 hour of meal. And take the medicine twice a day, with an interval of 12 hours as much as possible.
2. Renal toxicity. In addition to proper dosage and avoiding nephrotoxicity, cyclosporine should be avoided to be used together with other nephrotoxic drugs, such as common non-steroidal anti-inflammatory drugs such as ibuprofen and acetaminophen after a cold, and some nephrotoxic antibiotics, etc. Before using these drugs, you should first communicate with your nephrologist.
3. Usage in patients with Kidney Failure. If a patient ask: I have kidney failure. Can I use immunosuppressants? If the disease is very serious, immunosuppressants are usually no longer beneficial. For example, cyclosporine is not considered after glomerular filtration rate is less than 30ml/min (serum creatinine is higher than 442 umol/L). Of course, immunosuppressive agents can be used in some patients with renal failure, such as those whose renal function is not too severely damaged, and those whose renal disease has active lesions and whose renal function declines suddenly.
Now you have a clear mind on cyclosporine for kidney disease. If you still have any other questions on kidney disease treatment, please leave a message below or contact online doctor.
***Please seek professional medical advise for the diagnosis or treatment of any ailment, disease or medical condition. This article is not intended to be a substitute for the advice of a licensed medical professional.***