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Short-term Changes in Renal Function, Blood Pressure, and Electrolyte Levels in Patients Receiving Cyclosporine for Dermatologic Disorders

Short-term Changes in Renal Function, Blood Pressure, and Electrolyte Levels in Patients... Abstract We compared the changes in renal function, blood pressure (BP), and concentrations of serum potassium, magnesium, and urate (uric acid) in two groups of patients not given transplants. Group 1, comprising 21 psoriatic patients, was treated with 14 mg/kg per day of oral cyclosporine for 4 weeks in a prospective, placebo-controlled study; group 2, comprising 28 patients with diverse cutaneous diseases, was given 6 mg/kg per day of oral cyclosporine for 1 to 3 months in a prospective, open-labeled study. Renal function (determined by serum urea nitrogen [SUN] and creatinine levels and urinalysis), BP, serum electrolyte levels (potassium and magnesium), and urate level were measured weekly for the first 4 weeks in both groups, and then, after 2 and 3 months of therapy, in group 2 only. During the first 4 weeks in group 1 patients, there were significant increases in values of SUN, creatinine, BP, potassium, and urate, and a significant decrease in the serum magnesium value. When data for the two groups were combined, the changes from pretherapy values in each of the above measures (except systolic BP) during the first 4 weeks correlated significantly with cyclosporine trough levels. In group 2, the changes that occurred in the first 4 weeks in the SUN value, SUN/creatinine ratio, and BP were magnified over the subsequent 8 weeks of treatment. In the combined group for the first 4 weeks of therapy, duration of therapy, independent of cyclosporine trough levels, correlated with changes in SUN, creatinine, and urate levels, but not with changes in the potassium or magnesium level or in BP. We conclude that the cyclosporine blood level was a better discriminant than cyclosporine dosage in the analysis of renal dysfunction and hypertension in these patients. (Arch Intern Med. 1991;151:356-362) References 1. Borel JF. Comparative study of in vitro and in vivo drug effects on cell-mediated cytotoxicity . Immunology. 1976;31:631-641. 2. Calne RY, Rolles K, White DJG. Cyclosporin A initially as the only immunosuppressant in 34 recipients of cadaveric organs: 32 kidneys, 2 pancreas and 2 livers . Lancet. 1979;2:1033-1036.Crossref 3. Ellis CN, Gorsulowsky DC, Hamilton TA, et al. Cyclosporine improves psoriasis in a double-blind study . JAMA. 1986;256:3110-3116.Crossref 4. Gupta AK, Ellis CN, Cooper KD, et al. Oral cyclosporine A for the treatment of alopecia areata: a clinical and immunohistochemical analysis . J Am Acad Dermatol. 1990;22:242-250.Crossref 5. Gupta AK, Matteson EL, Ellis CN, et al. Cyclosporine A in the treatment of psoriatic arthritis . Arch Dermatol. 1989;125:507-510.Crossref 6. Gupta AK, Ellis CN, Nickoloff BJ, et al. Oral cyclosporine A in the treatment of inflammatory and non-inflammatory dermatoses: a clinical and immunopathologicalanalysis . Arch Dermatol. 1990;126:339-350.Crossref 7. White DJG, McNaughton D, Calne RY. Is the monitoring of cyclosporinA serum levels of clinical value? Transplant Proc. 1983;15:454-456. 8. Klintmalm G, Sawe J, Ringden O, von Buhr C, Magnusson A. Cyclosporine plasma levels in renal transplant patients . Transplantation. 1985;39:132-137.Crossref 9. Milliken GA, Johnson DE. The Analysis of Messy Data . New York, NY: Van Nostrand Reinhold Co; 1984;1. 10. Schluchter MD. BMDP 5V: Unbalanced Repeated Measures Models With Structured Covariance Matrices . Los Angeles, Calif: BMDP Statistical Software; 1988; BMDP technical report 86. 11. Dieperink H, Starklint H, Kemp E, Leyssac PP. Comparative pathophysiology and histopathology of cylosporine nephrotoxicity . Transplant Proc. 1988;20:785-791. 12. Sommer BG, Innef JT, Whitehurst RM, Sharma HM, Ferguson RM. Cyclosporine-associated renal arteriopathy resulting in loss of allograft function . Am J Surg. 1985;149:756-764.Crossref 13. Curtis JJ, Luke RG, Jones P, Diethelm AG. Hypertension in cyclosporine-treated renal transplant recipients is sodium dependent . Am J Med. 1988;85:134-138.Crossref 14. Keown PA, Stiller CR, Wallace AC, McKenzie FN, Wall W. Cyclosporine nephrotoxicity: exploration of the risk factors and prognosis of the renal injury . Transplant Proc. 1985;27:247-253. 15. Moss NG, Powell SL, Falk RJ. Intravenous cyclosporine activates afferent and efferent renal nerves and causes sodium retention in innervated kidneys in rats . Proc Nati Acad Sci U S A. 1985;82:8222-8226.Crossref 16. Bantle JP, Nath KA, Sutherland DER, Najarian JS, Ferris TF. Effects of cyclosporine on the renin-angiotensin-aldosterone system and potassium excretion in renal transplant recipients . Arch Intern Med. 1985;145:505-508.Crossref 17. Foley RJ, Van Buren CT, Hamner R, Weinmann EJ. Cyclosporine-associated hyperkalemia . Transplant Proc. 1983;25:2726-2729. 18. Palestine AG, Austin HA, Nussenblatt RB. Renal tubular function in cyclosporine-treated patients . Am J Med. 1986;81:419-424.Crossref 19. Berg KJ, Forre O, Bjerkhoel F, et al. Side effects of cyclosporin A treatment in patients with rheumatoid arthritis . Kidney Int. 1986;29:1180-1187.Crossref 20. Adu D, Michael J, Turney J, McMaster P. Hyperkalaemia in cyclosporin-treated renal allograft recipients . Lancet. 1983;1:370-372.Crossref 21. Barton CH, Vaziri ND, Martin DC, Chol S, Alikhani S. Hypomagnesemia and renal magnesium wasting in renal transplant recipients receiving cyclosporine . Am J Med. 1987;83:693-699.Crossref 22. Palestine AG, Austin HA, Balow JE, et al. Renal histopathologic alterations in patients treated with cyclosporine for uveitis . N Engl J Med. 1986;314:1293-1298.Crossref 23. Palestine AG, Austin HA, Nussenblatt RB. Cyclosporine-induced nephrotoxicity in patients with autoimmune uveitis . Transplant Proc. 1985;27:209-214. 24. June CH, Thompson CB, Kennedy MS, Loughran TP, Deep HG. Correlation of hypomagnesemia with the onset of cyclosporine-associated hypertension in marrow transplant patients . Transplantation. 1986;41:47-51.Crossref 25. Thompson CB, June CH, Sullivan KM, Thomas ED. Association between cyclosporin neurotoxicity and hypomagnesaemia . Lancet. 1984;1:1116-1120.Crossref 26. Weinmann EJ. Cyclosporine-associated hypertension . Am J Med. 1989;86:256-257.Crossref 27. Lin HY, Rocher LL, McQuillan MA, Schmaltz S, Palella TD, Fox IH. Cyclosporine induced hyperuricemia and gout: an ancient disease in a 'high tech'setting . N Engl J Med. 1989;321:287-292Crossref http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of Internal Medicine American Medical Association

Short-term Changes in Renal Function, Blood Pressure, and Electrolyte Levels in Patients Receiving Cyclosporine for Dermatologic Disorders

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Publisher
American Medical Association
Copyright
Copyright © 1991 American Medical Association. All Rights Reserved.
ISSN
0003-9926
eISSN
1538-3679
DOI
10.1001/archinte.1991.00400020106021
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Abstract

Abstract We compared the changes in renal function, blood pressure (BP), and concentrations of serum potassium, magnesium, and urate (uric acid) in two groups of patients not given transplants. Group 1, comprising 21 psoriatic patients, was treated with 14 mg/kg per day of oral cyclosporine for 4 weeks in a prospective, placebo-controlled study; group 2, comprising 28 patients with diverse cutaneous diseases, was given 6 mg/kg per day of oral cyclosporine for 1 to 3 months in a prospective, open-labeled study. Renal function (determined by serum urea nitrogen [SUN] and creatinine levels and urinalysis), BP, serum electrolyte levels (potassium and magnesium), and urate level were measured weekly for the first 4 weeks in both groups, and then, after 2 and 3 months of therapy, in group 2 only. During the first 4 weeks in group 1 patients, there were significant increases in values of SUN, creatinine, BP, potassium, and urate, and a significant decrease in the serum magnesium value. When data for the two groups were combined, the changes from pretherapy values in each of the above measures (except systolic BP) during the first 4 weeks correlated significantly with cyclosporine trough levels. In group 2, the changes that occurred in the first 4 weeks in the SUN value, SUN/creatinine ratio, and BP were magnified over the subsequent 8 weeks of treatment. In the combined group for the first 4 weeks of therapy, duration of therapy, independent of cyclosporine trough levels, correlated with changes in SUN, creatinine, and urate levels, but not with changes in the potassium or magnesium level or in BP. We conclude that the cyclosporine blood level was a better discriminant than cyclosporine dosage in the analysis of renal dysfunction and hypertension in these patients. (Arch Intern Med. 1991;151:356-362) References 1. Borel JF. Comparative study of in vitro and in vivo drug effects on cell-mediated cytotoxicity . Immunology. 1976;31:631-641. 2. Calne RY, Rolles K, White DJG. Cyclosporin A initially as the only immunosuppressant in 34 recipients of cadaveric organs: 32 kidneys, 2 pancreas and 2 livers . Lancet. 1979;2:1033-1036.Crossref 3. Ellis CN, Gorsulowsky DC, Hamilton TA, et al. Cyclosporine improves psoriasis in a double-blind study . JAMA. 1986;256:3110-3116.Crossref 4. Gupta AK, Ellis CN, Cooper KD, et al. Oral cyclosporine A for the treatment of alopecia areata: a clinical and immunohistochemical analysis . J Am Acad Dermatol. 1990;22:242-250.Crossref 5. Gupta AK, Matteson EL, Ellis CN, et al. Cyclosporine A in the treatment of psoriatic arthritis . Arch Dermatol. 1989;125:507-510.Crossref 6. Gupta AK, Ellis CN, Nickoloff BJ, et al. Oral cyclosporine A in the treatment of inflammatory and non-inflammatory dermatoses: a clinical and immunopathologicalanalysis . Arch Dermatol. 1990;126:339-350.Crossref 7. White DJG, McNaughton D, Calne RY. Is the monitoring of cyclosporinA serum levels of clinical value? Transplant Proc. 1983;15:454-456. 8. Klintmalm G, Sawe J, Ringden O, von Buhr C, Magnusson A. Cyclosporine plasma levels in renal transplant patients . Transplantation. 1985;39:132-137.Crossref 9. Milliken GA, Johnson DE. The Analysis of Messy Data . New York, NY: Van Nostrand Reinhold Co; 1984;1. 10. Schluchter MD. BMDP 5V: Unbalanced Repeated Measures Models With Structured Covariance Matrices . Los Angeles, Calif: BMDP Statistical Software; 1988; BMDP technical report 86. 11. Dieperink H, Starklint H, Kemp E, Leyssac PP. Comparative pathophysiology and histopathology of cylosporine nephrotoxicity . Transplant Proc. 1988;20:785-791. 12. Sommer BG, Innef JT, Whitehurst RM, Sharma HM, Ferguson RM. Cyclosporine-associated renal arteriopathy resulting in loss of allograft function . Am J Surg. 1985;149:756-764.Crossref 13. Curtis JJ, Luke RG, Jones P, Diethelm AG. Hypertension in cyclosporine-treated renal transplant recipients is sodium dependent . Am J Med. 1988;85:134-138.Crossref 14. Keown PA, Stiller CR, Wallace AC, McKenzie FN, Wall W. Cyclosporine nephrotoxicity: exploration of the risk factors and prognosis of the renal injury . Transplant Proc. 1985;27:247-253. 15. Moss NG, Powell SL, Falk RJ. Intravenous cyclosporine activates afferent and efferent renal nerves and causes sodium retention in innervated kidneys in rats . Proc Nati Acad Sci U S A. 1985;82:8222-8226.Crossref 16. Bantle JP, Nath KA, Sutherland DER, Najarian JS, Ferris TF. Effects of cyclosporine on the renin-angiotensin-aldosterone system and potassium excretion in renal transplant recipients . Arch Intern Med. 1985;145:505-508.Crossref 17. Foley RJ, Van Buren CT, Hamner R, Weinmann EJ. Cyclosporine-associated hyperkalemia . Transplant Proc. 1983;25:2726-2729. 18. Palestine AG, Austin HA, Nussenblatt RB. Renal tubular function in cyclosporine-treated patients . Am J Med. 1986;81:419-424.Crossref 19. Berg KJ, Forre O, Bjerkhoel F, et al. Side effects of cyclosporin A treatment in patients with rheumatoid arthritis . Kidney Int. 1986;29:1180-1187.Crossref 20. Adu D, Michael J, Turney J, McMaster P. Hyperkalaemia in cyclosporin-treated renal allograft recipients . Lancet. 1983;1:370-372.Crossref 21. Barton CH, Vaziri ND, Martin DC, Chol S, Alikhani S. Hypomagnesemia and renal magnesium wasting in renal transplant recipients receiving cyclosporine . Am J Med. 1987;83:693-699.Crossref 22. Palestine AG, Austin HA, Balow JE, et al. Renal histopathologic alterations in patients treated with cyclosporine for uveitis . N Engl J Med. 1986;314:1293-1298.Crossref 23. Palestine AG, Austin HA, Nussenblatt RB. Cyclosporine-induced nephrotoxicity in patients with autoimmune uveitis . Transplant Proc. 1985;27:209-214. 24. June CH, Thompson CB, Kennedy MS, Loughran TP, Deep HG. Correlation of hypomagnesemia with the onset of cyclosporine-associated hypertension in marrow transplant patients . Transplantation. 1986;41:47-51.Crossref 25. Thompson CB, June CH, Sullivan KM, Thomas ED. Association between cyclosporin neurotoxicity and hypomagnesaemia . Lancet. 1984;1:1116-1120.Crossref 26. Weinmann EJ. Cyclosporine-associated hypertension . Am J Med. 1989;86:256-257.Crossref 27. Lin HY, Rocher LL, McQuillan MA, Schmaltz S, Palella TD, Fox IH. Cyclosporine induced hyperuricemia and gout: an ancient disease in a 'high tech'setting . N Engl J Med. 1989;321:287-292Crossref

Journal

Archives of Internal MedicineAmerican Medical Association

Published: Feb 1, 1991

References