Calcineurin Inhibitors nephrotoxicity
Calcineurin Inhibitors nephrotoxicity can be divided into acute and chronic forms.
• Acute nephrotoxicity usually involves afferent vascular constriction and lower kidney blood flow, leading to kidney ischemia and damage. This resolves with either removal of the drug or lower drug levels. TMA secondary to CNIs can present acutely as well. TMA can also be seen in antibody-mediated rejection.
• Chronic CNI nephrotoxicity is seen histologically by global and focal glomerulosclerosis, arteriolar hyaline thickening, isometric tubular vacuolization, and focal areas of tubular atrophy and interstitial fibrosis. The fibrosis is classically seen in bands on biopsy and is called stripped fibrosis.