Cyclosporine toxicity in renal transplant recipients detected by nailfold capillaroscopy with Na-fluorescein

Détails

ID Serval
serval:BIB_760BC466D775
Type
Article: article d'un périodique ou d'un magazine.
Collection
Publications
Institution
Titre
Cyclosporine toxicity in renal transplant recipients detected by nailfold capillaroscopy with Na-fluorescein
Périodique
Kidney International
Auteur⸱e⸱s
Bongard  O., Weimer  D., Lemoine  R., Bolle  J. F., Leski  M., Bounameaux  H.
ISSN
0085-2538 (Print)
Statut éditorial
Publié
Date de publication
2000
Volume
58
Numéro
6
Pages
2559-2563
Notes
PT - Clinical Trial PT - Journal Article PT - Research Support, Non-U.S. Gov't
Résumé
BACKGROUND: Cyclosporine represented a major advance in the medical management of patients with organ transplantation, but its use is limited by the frequent occurrence of hypertension and renal toxicity diagnosed by invasive renal biopsy. Renal histology shows a specific arteriolopathy. It was hypothesized that cyclosporine may also induce subclinical microvascular changes in the skin that might be detected noninvasively by a combination of dynamic capillaroscopy [capillary blood cell velocity (CBV)] with and without intravenous Na-fluorescein (NaF) injection and laser Doppler fluxmetry (LDF). METHODS: The nailfold skin microcirculation was evaluated in 112 consecutive renal transplant recipients (54 +/- 11 years old; 70 males and 42 females) receiving cyclosporine. The investigation was made the same day as a routine renal biopsy performed in all patients more than two years after transplantation. Renal biopsies were blindly classified as positive (N = 33) when significant specific signs of cyclosporine toxicity were clearly observed (AH2-AH3) and were otherwise negative (AH0-AH1, N = 79) according to the Banff classification. RESULTS: Time to fluorescence peak after NaF injection (tpNaF) was significantly longer in patients with positive biopsies than in patients with negative biopsies (13.9 +/- 8.1 vs. 17.5 +/- 9.4 sec, P = 0.009). All patients but three with negative biopsies (93%) had a tpNaF less than 10 seconds (sensitivity 91%, negative predictive value 93%). On the other hand, CBV, LDF, plasma levels of cyclosporine, and endothelin were similar in the two groups. CONCLUSION: Nailfold fluorescence capillaroscopy is an accurate and simple mean to rule out cyclosporine toxicity in renal transplant recipients. A normal test could avoid invasive renal biopsy in about 40% of the patients. Renal biopsy would, however, still be indicated when the test is abnormal
Mots-clé
Adult/Biopsy/blood/Blood Flow Velocity/blood supply/Capillaries/classification/Contrast Media/Cyclosporine/diagnostic use/drug effects/drug therapy/Female/Fluorescein/Fluorescence/Graft Rejection/Histology/Humans/Hypertension/Immunosuppressive Agents/Kidney/Kidney Failure,Chronic/Kidney Transplantation/Laser-Doppler Flowmetry/Male/methods/Microcirculation/Middle Aged/Nails/Organ Transplantation/Pathology/pharmacokinetics/physiology/physiopathology/Research/Skin/Skin Temperature/surgery/Switzerland/toxicity/transplantation/ultrasonography/Urology
Pubmed
Web of science
Open Access
Oui
Création de la notice
29/01/2008 18:33
Dernière modification de la notice
20/08/2019 14:33
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