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Renal Changes Associated With Cyclosporine In Recent Type I Diabetes Mellitus
M. Rodier, J. Ribstein, C. Parer-Richard, A. Mimran
Published 1991 · Medicine
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The effects of cyclosporine A treatment on arterial pressure and renal function were assessed in 11 young patients with type I diabetes of short duration. Cyclosporine was started at 7.5 mg/kg/day, progressively decreased to 63 mg/kg/day at 6 months, and then continued at a lower dose (4.1 mg/kg/day) for an additional 3 months in patients in whom remission of insulin dependency was obtained (n=6). After 3 months of cyclosporine, a slight but significant increase in arterial pressure (+5.2±1.5 mm Hg), a rise in renal vascular resistance (—20%), a decrease in glomerular filtration rate (—25%), and a fall in filtration fraction were observed. Such changes were sustained after 6 and eventually 9 months of therapy. The decrease in glomerular filtration rate observed during cyclosporine treatment contrasted with the lack of change in simultaneously estimated creatinine clearance; in fact, the creatinine clearance/ glomerular filtration ratio increased from 1.07±0.05% to 1.33±0.09% within 3 months of cyclosporine therapy, thus suggesting an enhanced tubular secretion of creatinine. Plasma renin activity and urinary excretion of kallikrein decreased significantly (—50%), whereas plasma aldosterone concentration remained unaltered and plasma concentration of potassium increased during cyclosporine therapy. These changes were observed in the presence of a constant urinary excretion of sodium and potassium and a constant body weight All parameters returned to pretreatment values within 3 months after cessation of cyclosporine. These results indicate that cyclosporine given for 6-9 months at a moderate dose causes a deleterious but reversible effect on arterial pressure and renal function in young diabetic patients.
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KEY WORDS • renal function • kallikrein • cyclosporine renin • diabetes
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