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Calcineurin inhibitors and nephrotoxicity in children

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Abstract

Background

Calcineurin inhibitors (CNIs) are commonly given to transplant recipients of kidneys and other solid organs and to patients with immune disorders, such as steroid-resistant nephrotic syndrome, steroid-dependent nephrotic syndrome, and frequent relapse nephrotic syndrome. Although CNIs remain the most effective available immunosuppressant agent, there is clinical concern regarding possible long-term nephrotoxicity. This concern is especially significant in children who have a longer life expectancy and greater growth rate.

Data sources

In this review, we analyzed the literatures to identify original articles that examined use of CNIs in children who received organ transplantation and nephropathy to assess the available evidence of their nephrotoxicity. PubMed, Elsevier, and Tompson ISI Web of Knowledge were searched for identifying relevant papers.

Results

Clinical research supports the presence of CNI-related nephrotoxicity. However, some researchers have questioned the prevalence and seriousness of chronic CNIs nephrotoxicity, especially because the pathological lesions typically associated with long-term CNI use are nonspecific. Many researchers have focused on early markers of CNI nephrotoxicity, and the methods that may help prevent and manage nephrotoxicity.

Conclusions

Future research should focus on investigating early markers of CNI nephrotoxicity and strategies for improved immunosuppressant therapy, and developing alternative treatments. CNI-mediated nephrotoxicity should always be taken seriously in clinic.

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Funding

This work was supported by the following grants: the National Natural Science Foundation of China (81470939, 81270792 and 81170664), the Specialized Research Fund for the Doctoral Program of Higher Education (20120101110018), the Natural Science Foundation of Zhejiang Province (LH14H050002, LY15H050001), and the Medicine & Health Technology Innovation Project of Zhejiang Province (2014KYA123).

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  1. Department of Nephrology, Children’s Hospital, Zhejiang University School of Medicine, Hangzhou 310003, China

    Fei Liu & Jian-Hua Mao

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  1. Fei Liu
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All authors contributed to the preparation of this review and approved the text.

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Correspondence to Jian-Hua Mao.

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Ethical approval was issued by the Research Ethics Committee of The Children Hospital of Zhejiang University School of Medicine.

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Liu, F., Mao, JH. Calcineurin inhibitors and nephrotoxicity in children. World J Pediatr 14, 121–126 (2018). https://doi.org/10.1007/s12519-018-0125-y

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