-transparent.png){kind=logo}
Twenty-two patients with heart, lung or heart and lung transplants maintained on cyclosporin for periods ranging from 3 months to 10 years developed renal insufficiency which was investigated by renal biopsy. The histopathological changes were: (i) severe vascular and glomerular damage due to thrombotic microangiopathy (TM); (ii) a form of focal segmental glomerulosclerosis (FSGS); (iii) glomerular ischaemia. Rather than being separate entities, these changes appeared to represent a spectrum of pathology, some biopsies showing all three forms of glomerular injury. In all cases the glomerular changes were accompanied by arteriolar and arterial pathology, and we identified novel ultrastructural changes in the arteriolar endothelial basal lamina. Tubular atrophy was a consistent feature, the severity of which reflected the severity of the glomerular sclerosis, and which appeared to be a consequence of glomerular loss. Our findings are consistent with the nephrotoxic effects of cyclosporin being mediated chiefly via damage to preglomerular vessels and glomerular capillary endothelium. From an analysis of the clinical aspects of these cases, the effects of cyclosporin appear to be to some extent idiosyncratic, and therefore not entirely preventable, but strict monitoring of blood cyclosporin levels is essential to minimize the risk of permanent renal damage. Monitoring urinary protein in addition to plasma creatinine may detect the onset of FSGS, as proteinuria precedes creatinine elevation.
M H Griffiths, and
A V Crowe, and
L Papadaki, and
N R Banner, and
M H Yacoub, and
F D Thompson, and
G H Neild
October 1987,
Presse medicale (Paris, France : 1983),
M H Griffiths, and
A V Crowe, and
L Papadaki, and
N R Banner, and
M H Yacoub, and
F D Thompson, and
G H Neild
January 1981,
Proceedings of the European Dialysis and Transplant Association. European Dialysis and Transplant Association,
M H Griffiths, and
A V Crowe, and
L Papadaki, and
N R Banner, and
M H Yacoub, and
F D Thompson, and
G H Neild
February 1981,
Lancet (London, England),
M H Griffiths, and
A V Crowe, and
L Papadaki, and
N R Banner, and
M H Yacoub, and
F D Thompson, and
G H Neild
July 1981,
Lancet (London, England),
M H Griffiths, and
A V Crowe, and
L Papadaki, and
N R Banner, and
M H Yacoub, and
F D Thompson, and
G H Neild
December 1990,
Clinical pharmacokinetics,
M H Griffiths, and
A V Crowe, and
L Papadaki, and
N R Banner, and
M H Yacoub, and
F D Thompson, and
G H Neild
September 1981,
Lancet (London, England),
M H Griffiths, and
A V Crowe, and
L Papadaki, and
N R Banner, and
M H Yacoub, and
F D Thompson, and
G H Neild
October 1994,
The Medical journal of Australia,
M H Griffiths, and
A V Crowe, and
L Papadaki, and
N R Banner, and
M H Yacoub, and
F D Thompson, and
G H Neild
January 1995,
Transplant international : official journal of the European Society for Organ Transplantation,
M H Griffiths, and
A V Crowe, and
L Papadaki, and
N R Banner, and
M H Yacoub, and
F D Thompson, and
G H Neild
July 1985,
Lancet (London, England),
M H Griffiths, and
A V Crowe, and
L Papadaki, and
N R Banner, and
M H Yacoub, and
F D Thompson, and
G H Neild
May 1983,
British journal of haematology,
