Una nueva percepción del papel de la aldosterona en la fisiopatología de la nefrotoxicidad crónica inducida por la ciclosporina
Resumen
La ciclosporina A (CsA), un inhibidor de la calcineurina, ha mejorado la supervivencia de injertos del trasplante de órganos sólidos y su uso para manejar las enfermedades autoinmunitarias es cada vez más común. Si bien las tasas de supervivencia de pacientes y de injertos han aumentado, el uso clínico de la CsA es limitado ya que frecuentemente tiene efectos nefrotóxicos, que se pueden presentar en dos formas distintas y bien caracterizadas: nefrotoxicidad aguda y crónica. La forma aguda se caracteriza por vasoconstricción renal inducida por un desequilibrio en la liberación de sustancias vasoactivas, lo que conduce a una disfunción renal. Esta forma de nefrotoxicidad es reversible. La toxicidad crónica, por su parte, se caracteriza por vaso constricción y daño estructural que incluye patologías de las arteriolas y fibrosis tubulointersticial, las cuales, por lo general no son reversibles.Los mecanismos de estos efectos perjudiciales no se conocen con exactitud, aunque, en los últimos años, se han hecho grandes avances. En este artículo revisamos la literatura actual sobre la patogenia y las estrategias de tratamiento que se han utilizado para mejorar el daño renal causado por la nefrotoxicidad crónica por CsA. Recientemente se ha sugerido que la aldosterona juega un papel central en la patogenia de la nefrotoxiddad causada por CsA y que la espironolactona puede ser útil para prevenirla. Se discuten estos resultados y el uso del bloqueo de los receptores de mineralocorticoides.
Citas
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