New insight on the role of aldosterone in the pathophysiology of chronic nephrotoxicity induced by cyclosporine [Una nueva percepción del papel de la aldosterona en la fisiopatología de la nefrotoxicidad crónica inducida por la ciclospori
Por:
Bobadilla N.A., Gamba G.
Publicada:
1 ene 2008
Resumen:
Cyclosporine A (CsA) is a calcineurin inhibitor widely use to prevent organ transplant rejection and for treating autoimmune diseases. Since CsA introduction, organ transplant and patient survival significantly increased and this outcome has not been modified by the new immunosuppressive agents. The long use of CsA, however has been limited because its nephrotoxic side effect. Two forms of renal toxicity have been described, the acute and the chronic toxicty. Acute nephrotoxicity is characterized by renal dysfunction produced by an increase in vasoconstrictor factors that is reversible if CsA dose is reduced or even more if it is withdrawal. Whereas, chronic CsA nephrotoxicity is characterized by renal vasoconstriction and the concomitant development of arteriolopathy and tubulo-interstitial fibrosis. This form is non-reversible and might progress to chronic renal insufficiency. Although the exact mechanisms by which CsA induced renal damage are not completely established, several advances have made to prevent CsA nephrotoxity. This review discusses the pathophysiology and the pharmacological strategies proved to reduce this CsA nephropathy, emphasizing the studies that have concentrated to study the effect of mineralocorticoid receptors blockade during the renal injury induced by CsA.
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