Cyclosporine-Associated Nephrotoxicity

Cyclosporine (CsA) has revolutionized transplant medicine and is currently one of the most important immunosuppressive agents for a wide range of organ transplantations and of autoimmune and inflammatory diseases, such as rheumatoid arthritis, uveitis, psoriasis, and atopic dermatitis. Renal impairment represents the main limitation to CsA long-term continuous therapy. However, it has been shown that nephrotoxicity is associated with longer treatment duration, larger cumulative doses and higher daily dose of CsA. With low dose regimens (<5 mg/kg/day), stable serum creatinine levels have been observed up to 15-20 years after kidney transplantation. Intermittent therapy may offer a good therapeutic strategy to limit long-term renal dysfunction, given the fact that renal structural changes are dose- and time-dependent. The best predictor of permanent renal damage is a persistent increase in serum creatinine level one month after treatment withdrawal. In patients with autoimmune diseases, the percentage increase in serum creatinine above baseline value during CsA therapy has been shown to predict CsA-induced nephropathy. Before CsA therapy initiation, patients should undergo a thorough baseline evaluation including laboratory assessments, in particular electrolytes, serum creatinine, and urea levels. Furthermore, patients should be evaluated for factors that might increase the risk of nephrotoxicity, such as obesity, older age, hypertension, concomitant use of nephrotoxic drugs, and pre-existing renal conditions. In the present paper, CsA-induced nephropathy will be reviewed in terms of pathophysiology, pathologic and clinical findings, and strategies for prevention and management.

Gender medicine and psoriasis

The study of specific differences between women and men is arousing huge interests in various fields of medicine, including dermatology. The available data on gender medicine applied to common skin diseases are unfortunately still scanty. Psoriasis is a chronic immunemediated skin disease which affects 1%-3% of most populations worldwide and can involve also the joints and entheses. The pathogenesis of the disease is very complex, resulting from the interaction between genetic predisposition and several environmental triggers. The pathogenic role of sex hormones has also been hypothesized. The analysis of gender-specific differences in psoriasis seems to suggest some interesting findings, such as an earlier age of disease onset in females, a higher probability of severe disease in men, or different tendencies in care utilization, adherence to treatment, development of psychological distress, and coping strategies. Moreover, sex-related differences have been recently described in some epidemiological and clinical features among patients with psoriatic arthritis. The objective of this article is to review briefly the available evidence regarding gender differences in various aspects of psoriasis, such as epidemiology, genetics, risk factors, associated conditions, quality of life, clinical and therapeutic aspects.