Nephrotoxicity of Cyclosporin a after Allogeneic Marrow Transplantation: Glomerular Thromboses and Tubular Injury

CYCLOSPORIN A, a fungal metabolite, is a potent new immunosuppressive drug^1,2 that has been reported to prevent or ameliorate rejection of kidney and liver allografts^{3 4 5} and graft-versus-host disease after allogeneic marrow transplantation.^6,7 A potentially harmful side effect of therapy with cyclosporin A is renal toxicity. Previous reports of nephrotoxicity after cyclosporin A have emphasized the mild and transient elevations of blood urea nitrogen (BUN) and creatinine.^{3 4 5 6 7 8 9} We now describe a distinct histologic constellation of glomerular thromboses and severe tubular damage, which correlated with the clinical course and laboratory findings of severe renal failure in three recipients of allogeneic marrow who.