A recent article in Kidney International discusses the negative and positive aspects of this interesting drug- sirolimus, mTOr inhibitor. Initially designed to fight renal cancer, fast caught on to treat rejection and be used as an immunosuppression.
1. Six trials so far have randomized sirolimus vs a calcineurin inhibitor that were mentioned in this article. They all had more acute rejection episodes with sirolimus. So graft survival is a concern.
2. Renal toxicity has been described- from TMA to collapsing FSGS and severe proteinuria making it not as promising as CNI. But CNI have a more chronic toxicity to the kidney
3. Dyslipidemia has been noted as well more with this agent. - close to 60% of the patients getting mTor in clinical trials required lipid lowering agents
4. NODAT was also noted to be higher in this group; 25% more chance than CNI
5. Wound healing:- preventing the surgical wound healing or in future if patients need other surgeries makes it tough.
6. Other- mouth ulcers, myelosuppresion and infertility were more common in this agent as well.
7. Finally, they mention the new findings lately described pulmonary toxicities that are leading to a restrictive disease in the lung.
- ► 2018 (55)
- ► 2017 (52)
- ► 2016 (45)
- ► 2015 (63)
- ► 2014 (95)
- ► 2013 (133)
- ► 2012 (201)
- ► 2011 (370)
- CONSULT ROUNDS: Propofol Infusion Syndrome
- Sirolimus - The negative aspects
- Nephsap review: Fluids Electrolytes
- CLINICAL CASE 29, ANSWERS AND SUMMARY
- ASN 2010 - Live update: "Onco Nephrology"
- Video: The Treatment of Resistant Nephrotic Syndro...
- ASN 2010 Live Update - Late Breaking Trials
- Dialysis Access Atlas from Fistula First. Check it...
- Access Educational Tool
- ASN 2010 Live Update- Nephrology Education
- ASN 2010 Live Update - hyponatremia
- ASN 2010 Live Update - Transplantation in the Elde...
- ASN 2010 Live Update- KDIGO guidelines for HTN
- ASN Live Update 2010: Drugs in Osteoporosis and CK...
- ASN Live Update 2010; CKD -BMD or Osteoporosis
- ASN Live Update 2010: Osteoporosis, steroid induce...
- ASN Live Update 2010; Is fibrosis harmful? in the ...
- ASN Live Update 2010: Glomerular Damage leading to...
- ASN Live Update 2010: VEGF and Diabetic Nephropath...
- ASN Live Update 2010: VEGF and the podocyte
- ASN Live Update 2010: Cirrhosis and the Kidney
- ASN Live updates from nephrology on demand
- ASN Live Update 2010:when do to combined liver-kid...
- Diet and CKD - Historical Interest
- The Kidney Transplant in HIV patients- the NEJM st...
- ASN 2010 Live Update - Careers in nephrology
- What Dialysis Modality you would want? Survey
- Presentations from the Prevention in Renal Disease...
- Medicine for residents: urinalysis in rhabdomyolys...
- CKD videos from The Visual MD
- IN THE NEWS- DENSE DEPOSIT DISEASE AND MGUS?
- New Website
- JOURNAL CLUB: FGF 23 and UREMIC parathyroid glands...
- Medicine for residents: Hyperkalemia with beta blo...
- CONSULT ROUNDS: Risk Factors of Contrast Induced N...
- The Tips to Keep Your Kidney Healthy- Old Folk Son...
- IN THE NEWS--> DIALYSIS PROPUBLICA ARTICLE
- TOPIC DISCUSSION: "Onco" Nephrology
- Medicine for residents: Chlorthalidone.......what ...
- 5 Major Effects of High Blood Pressure - 3D Medica...
- History of Nephrology: Hepatitis outbreaks run thr...
- IN THE NEWS- ANTI FACTOR H antibodies and TMA
- Tubulointerstitial Nephritis
- CONSULT ROUNDS: UREMIC LUNG
- CLINICAL CASE 28, ANSWERS AND SUMMARY
- Quiz 8 answers
- TOPIC DISCUSSION: Secondary Oxalate Nephropathy
- Nephrogenic Systemic Fibrosis-An Evolving Disease ...
- Top Transplant Programs "by volume" in 2009, check...
- Nephsap review: AKI and ICU Nephrology
- ▼ November (51)