Renal Function and Blood Pressure in Patients Receiving Long-Term, Low-Dose Cyclosporine Therapy for Idiopathic Autoimmune Uveitis

Abstract

▪ Objective: To determine the renal side effects of long-term, low-dose cyclosporine therapy (initial dose, 5 mg/kg body weight per day) in patients with autoimmune idiopathic uveitis.

▪ Design: Cohort study with at least 2 years of follow-up.

▪ Setting: A teaching hospital in Paris, France (Hôpital Pitié-Salpétrière).

▪ Patients: Sixteen patients with idiopathic autoimmune uveitis who were normotensive and had normal renal function before treatment. Cyclosporine was administered orally for at least 2 years at an initial dosage of 5 mg/kg body weight per day.

▪ Results: After 2 years of treatment, the serum creatinine level increased by 35 ± 5 µmol/L (0.40 ± 0.06 mg/dL) (95% CI, 25 to 46 µmol/L, [73 ± 4 to 108 ± 4 µmol/L]). Creatinine clearance decreased significantly from 120 ± 5 mL/min to 75 ± 4 mL/min. Glomerular filtration rate decreased from 116 ± 8 mL/min to 75 ± 3 mL/min, and effective renal plasma flow decreased from 455 ± 24 mL/min to 338 ± 30 mL/min (P < 0.05). Cyclosporine induced a significant increase in serum uric acid, total cholesterol, and serum potassium levels. Blood pressure was normal in all patients before treatment; 81% (95% CI, 64% to 98%) of these patients developed hypertension after 24 months of treatment. Blood pressure was controlled with a single drug in all but two patients.

▪ Conclusions: In patients with healthy native kidneys, long-term cyclosporine therapy, even at a low dose (5 mg/kg per day), is nephrotoxic and is associated with a high incidence of hypertension.