Chronic nephrotoxicity complicating cyclosporine treatment of chronic inflammatory demyelinating polyradiculo-neuropathy

We elected to use cyclosporin A (CsA) in a woman debilitated by refractory chronic inflammatory demyelinating polyradiculoneuropathy. Although strength improved coincident with CsA therapy, after 21 months she developed congestive heart failure and had a precipitous loss of renal function with chronic renal failure requiring hemodialysis. While most CsA-induced nephrotoxicity is dose related and reversible, the kidney biopsy in our patient showed chronic nephropathy, a complication previously unreported in the native kidney of a nontransplant patient. A slow rise in blood pressure preceded serum creatinine changes and was an early indicator of impending irreversible nephrotoxicity.