Cyclosporine and Kidneys

[TonyBegg]

Sorry if this is a repeat. Karin had hATG a couple of weeks ago and they started her on Cyclosporine. But she has had scary kidney function numbers in blood tests (e.g. eGFR of 25, should be > 90) and her hematologist has taken her off the Cyclosporine. Which bothers us because CsA is part of the protocol (Karin has SAA and 95% PNH clone) and we are concerned it might not work. We see a nephrologist (kidney specialist) on Tuesday. I have read an abstract that suggests the kidney function impairment with Cyclosporine is partial (still good urine flow and other things, just high creatinine and BUN), and reversible. Have any of you had this problem and been able to get back on the Cyclosporine with some regime to keep the kidneys from totally failing??

[Hopeful]

ATG is really hard on the kidneys. So, it is probably wise to remove the cyclosporine for a bit to allow things to recover. In the big scheme of things, not taking the cyclosporine for a week or so while her kidneys heal probably won't make that much of a difference - the ATG is the big gun right now in wiping out the rogue T-cells.

There have been a few times when my GFR has been in the 50's, but it always recovered by the next blood test. My elevated creatinine would also recover when my cyclosporine dosage was lowered.

Had they been measuring Karin's cyclosporine trough levels to make sure that her dosage wasn't too high?

Make sure that she is drinking a lot of water all day long. Also, keep track of her baseline (before drugs) creatinine numbers. To prevent irreversible kidney damage from cyclosporine, the creatinine level should ideally not increase more than 33% from the baseline. (This is from the drug manufacturer.)

[TonyBegg]

Thank you so much. Wasn't sure whether it was inexperienced doctor (AA and PNH are both rare enough that even hematologists don't encounter many cases). Karin was having her serum Cyclosporine levels monitored and first they increased the dosage from 575 mg to 600 mg because of that. But then her kidneys which had appeared healthy prior to immune suppression started to complain. Electrolytes all over the place and her Creatinine and GFR wrong. So they reduced the dose to 300, then 200, then off it. I had been hoping most of the kidney function was OK (read some papers on the Internet) and just the indicators were wrong, but seems that was not the case. I hope the horse ATG is sufficient because not many options left. I wish eltrombopag was approved since it is reported as shortening the time needed on Cyclosporine before marrow recovery.