Effects of Ciclosporin on Plasma Renin Activity, Catecholamines and Prostaglandins in Patients with Idiopathic Uveitis

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Abstract
Animals and humans undergoing treatment with ciclosporin (CS) show a reversible increase in renal vascular resistance and a decrease in glomerular filtration rate. The causes of these abnormalities have not yet been established. We evaluated the effects of a 1-week treatment with CS on creatinine clearance, renal arachidonic acid metabolites, plasma renin activity (PRA), plasma aldosterone levels, urinary excretion and plasma levels of catecholamines in 7 patients with idiopathic uveitis. We show that CS treatment induces a significant (p < 0.05) decrease in creatinine clearance (from 132 ± 0.5 to 108 ± 8 ml/min); urinary 6-keto-PGF1 excretion (from 17.8 ± 4.9 to 10.9 ± 3.3 ng/mmol creatinine), urinary thromboxane B2 excretion (from 7.0 ± 1.0 to 3.6 ± 0.9 ng/mmol creatinine), upright PRA (from 4.2 ± 0.9 to 2.3 ± 0.8) and supine PRA (from 2.0 ± 0.5 to 1.1 ± 0.3). We found no change in plasma aldosterone levels and plasma levels and urinary excretion of catecholamines. We suggest that the reversible renal vasoconstriction observed in patients treated with CS may be induced by inhibition of renal prostacyclin synthesis. In this setting inhibition of PRA and angiotensin II formation may impair autoregulation of effective filtration pressure and therefore glomerular filtration rate.