Subtoxic doses of calcineurin inhibitors induce predisposition to acute kidney injury

2015 ◽  
Vol 238 (2) ◽  
pp. S258
Author(s):  
M. Prieto ◽  
A.G. Casanova ◽  
M.T. Hernández-Sánchez ◽  
L. Vicente-Vicente ◽  
M. Pescador ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Calcineurin Inhibitors ◽  
Kidney Injury

Serial Quantification of Urinary Protein Biomarkers to Predict Drug-induced Acute Kidney Injury

2019 ◽  
Vol 20 (8) ◽  
pp. 656-664 ◽  
Author(s):  
Yi Da ◽  
K. Akalya ◽  
Tanusya Murali ◽  
Anantharaman Vathsala ◽  
Chuen-Seng Tan ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Cystatin C ◽  
Calcineurin Inhibitors ◽  
Kidney Injury ◽  
Tubular Dysfunction ◽  
Renal Tubular Dysfunction ◽  
Protein Biomarkers ◽  
Drug Induced ◽  
Beta 2 ◽  
Beta 2 Microglobulin

Background: : Drug-induced Acute Kidney Injury (AKI) develops in 10-15% of patients who receive nephrotoxic medications. Urinary biomarkers of renal tubular dysfunction may detect nephrotoxicity early and predict AKI. Methods:: We prospectively studied patients who received aminoglycosides, vancomycin, amphotericin, or calcineurin inhibitors, and collected their serial urine while on therapy. Patients who developed drug-induced AKI (fulfilling KDIGO criteria) were matched with non-AKI controls in a 1:2 ratio. Their urine samples were batch-analyzed at time-intervals leading up to AKI onset; the latter benchmarked against the final day of nephrotoxic therapy in non- AKI controls. Biomarkers examined include clusterin, beta-2-microglobulin, KIM1, MCP1, cystatin-C, trefoil-factor- 3, NGAL, interleukin-18, GST-Pi, calbindin, and osteopontin; biomarkers were normalized with corresponding urine creatinine. Results:: Nine of 84 (11%) patients developed drug-induced AKI. Biomarkers from 7 AKI cases with pre-AKI samples were compared with those from 14 non-AKI controls. Corresponding mean ages were 55(±17) and 52(±16) years; baseline eGFR were 99(±21) and 101(±24) mL/min/1.73m2 (all p=NS). Most biomarker levels peaked before the onset of AKI. Median levels of 5 biomarkers were significantly higher in AKI cases than controls at 1-3 days before AKI onset (all µg/mmol): clusterin [58(8-411) versus 7(3-17)], beta-2-microglobulin [1632(913-3823) versus 253(61-791)], KIM1 [0.16(0.13-0.76) versus 0.07(0.05-0.15)], MCP1 [0.40(0.16-1.90) versus 0.07(0.04-0.17)], and cystatin-C [33(27-2990) versus 11(7-19)], all p<0.05; their AUROC for AKI prediction were >0.80 (confidence intervals >0.50), with average accuracy highest for clusterin (86%), followed by beta-2-microglobulin, cystatin-C, MCP1, and KIM1 (57%) after cross-validation. Conclusion: : Serial surveillance of these biomarkers could improve the lead time for nephrotoxicity detection by days.

scholarly journals Acute Kidney Injury Following Exposure to Calcineurin Inhibitors in a Patient with Idiopathic Membranous Nephropathy

2019 ◽  
Vol 6 (1) ◽  
Author(s):  
Maciej Goździk ◽  
Agnieszka Płuciennik ◽  
Anna Zawiasa-Bryszewska ◽  
Maja Nowicka ◽  
Zuzanna Nowicka ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Membranous Nephropathy ◽  
Calcineurin Inhibitors ◽  
Kidney Injury ◽  
Idiopathic Membranous Nephropathy

scholarly journals ACUTE TACROLIMUS-INDUCED KIDNEY INSUFFICIENCY IN PATIENT AFTER HEART TRANSPLANTATION

2016 ◽  
Vol 18 (1) ◽  
pp. 53-57
Author(s):  
D. V. Doronin ◽  
A. M. Chernyavskiy ◽  
A. V. Fomichev ◽  
M. N. Deryagin ◽  
V. N. Gorbatykh
Keyword(s):  
Acute Kidney Injury ◽  
Side Effects ◽  
Heart Transplantation ◽  
Immunosuppressive Therapy ◽  
Clinical Case ◽  
Standard Dose ◽  
Transplant Rejection ◽  
Calcineurin Inhibitors ◽  
Kidney Injury ◽  
Kidney Insufficiency

In recent years the success of transplantation is associated primarily with extensive use of calcineurin inhibitors (CNIs) – cyclosporine and tacrolimus which became the basis of the various immunosuppressive therapy protocols. These drugs despite their effectiveness in the prevention of transplant rejection have serious side effects. Nephrosclerosis due to chronic nephrotoxic effect is recognized as the most important of them. But along with chronic nephrotoxic effects there are cases of acute kidney injury on the background of calcineurin inhibitors usage. The article presents a clinical case demonstrating the development of severe reversible nephropathy in a patient after heart transplantation receiving tacrolimus in standard dose.

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