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TABLA I
FACTORES ETIOLÓGICOS IMPLICADOS EN LA NEFROTOXICIDAD POR CICLOSPORINA

1.- Aumento de la reactividad vascular a ciertos vasoconstrictores.

2.- Baja reactividad a ciertos vasodilatadores.
3.- Activación del sistema renina-angiotensina II.
4.- Aumento del calcio intracelular.
5.- Lesión endotelial y liberación de endotelina.
6.- Baja producción de prostaciclinas vasodilatadoras.

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TABLA II
INTERACCIONES FARMACOLÓGICAS MÁS COMUNES DE LA CICLOSPORINA

AUMENTAN EL NIVEL DE CsA DISMINUYEN EL NIVEL DE CsA

Calcioantagonistas
Diltiazem
Verapamil
Nicardipino

Antibióticos
Eritromicina Nafcilina
Ticarcilina Timetropin-sulfametoxazol iv
Doxiciclina Isoniazida
Fluconazol Rifampicina
Ketoconazol

Anticonvulsionantes
Fenitoina
Fenobarbital
Carbamazepina
Primidon

Otras
Hormonas sexuales Omeprazol
Colchicina Sulfínprirazona
Metoclopramida
FK 506
Tamoxifén
Alcohol

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TABLA III
FACTORES DE RIESGO PARA EL DESARROLLO DE NEFROTOXICIDAD
CRÓNICA POR CICLOSPORINA

1.- Número de episodios de deterioro agudo de la función renal inducidos por CyA.
2.- Niveles valle de CyA en los tres primeros meses postrasplante.
3.- Número de episodios de deterioro agudo de la función renal inexplicados.
4.- Número de fármacos nefrotóxicos.
5.- Número de episodios de rechazo.
6.- Número de tratamientos antirrechazo.
7.- Función renal previa al trasplante.

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(11,4 %)
(7,9 %)
(1,2 %)
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Función renal al primer año tras el trasplante cardíaco (número de pacientes 5827). Registro de la Sociedad Internacional
de Trasplante Cardíaco y Pulmonar. Informe 1999.

(14,6 %)

(7,4 %)

(1,9 %) Normal

IR leve

Cr > 2,5 mg %

(76,1 %) Diálisis

Función renal al cuarto año tras el trasplante cardíaco (número de pacientes 713). Registro de la Sociedad Internacional
de Trasplante Cardíaco y Pulmonar. Informe 1999.
Figura 1

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