Calcineurin Inhibitors (CNIs)

What are Calcineurin Inhibitors (CNIs)?

Calcineurin Inhibitors remain a cornerstone of immunosuppressive regiments in kidney transplantation.

This class of drugs works by blocking calcineurin, an intricate protein in the signal transduction pathway that activates signal 3. The two prototypes of the class are tacrolimus and cyclosporine, with tacrolimus being the primary drug of choice today.

The side effects of the Calcineurin Inhibitors include:

• Nephrotoxicity (discussed in next question)

• Thrombotic microangiopathy (TMA)

• New onset diabetes after transplant

• Hypertension

• Tremor

• Hypercalciuria, hyperkalemia, and hypomagnesemia

• Alopecia (Tacrolimus,)

• Hirsutism, gingival hyperplasia, hyperuricemia, metabolic acidosis, hypophosphatemia (Cyclosporine)