ATLAS OF RENAL PATHOLOGY

The Atlas of Renal Pathology presents a compilation of figures on a specific pathologic entity. You should read the Terms and Conditions of Use before using this site. If you agree to the terms, you may download the figures to create your own personal, noncommercial library of images or to create slides for teaching purposes.

To view a larger version of each figure, select View larger version below each figure. To make a slide, select download slide-quality image file. Download times may be somewhat lengthy. For tips on preparing slides from the files, please see Downloading Images for Slide Preparation.

Cyclosporine Toxicity

Pathology Editor: Agnes Fogo, MD
Medical Photographer: Brent Weedman

 
View larger version
Download slide-quality image
Fig 1. Cyclosporine nephrotoxicity may manifest in many different ways. Perhaps the most common morphology is that of a normal kidney, since cyclosporine can cause renal dysfunction by inducing vasoconstriction in the absence of morphological damage. In addition, cyclosporine has been implicated in thrombotic microangiopathy, which may involve the arterioles, as shown in this case. (Jones' silver stain, original magnification X200).
 
 
View larger version
Download slide-quality image
Fig 2. Cyclosporine nephrotoxicity has been implicated in thrombotic microangiopathy, which may involve arterioles (see Fig 1), and also the glomerular tuft, as shown in this case. However, thrombotic microangiopathy can also occur in the absence of cyclosporine, be due to FK506, or be due to recurrence of disease in the rare cases of familial hemolytic renal syndrome. (Jones' silver stain, original magnification X400).
 
 
View larger version
Download slide-quality image
Fig 3. Cyclosporine may also cause chronic glomerular injury, and result in segmental sclerosis, typically superimposed on ischemic changes. In this case, there is sharply delineated segmental sclerosis with glomerular basement membrane corrugation and lamellation and thickening of Bowman's capsule. In this case, there is also severe arteriolar hyalinosis, another lesion associated with cyclosporine toxicity (see below). (Jones' silver stain, original magnification X400).
 
 
View larger version
Download slide-quality image
Fig 4. Cyclosporine toxicity also causes arteriolar hyalinization. This must be differentiated from preexisting arteriolar hyalin in the graft nonspecifically associated with, for instance, hypertension. The classic cyclosporine-associated arteriolar hyalin was described as involving the media with a concentric appearance due to vascular smooth muscle cell injury. Concentric hyalin and medial vacuolization is present in this case of cyclosporine toxicity. (Periodic acid-Schiff, original magnification X200).
 
 
View larger version
Download slide-quality image
Fig 5. Arteriolar hyalin extending into the media or new onset arteriolar hyalinization are suggestive of cyclosporine toxicity, as in this case. (Periodic acid-Schiff, original magnification X200).
 
 
View larger version
Download slide-quality image
Fig 6. Cyclosporine toxicity may also manifest as striped interstitial fibrosis. This pattern may not be easily detected in needle biopsies, but in open biopsies, as in this case, the fibrosis extending along medullary rays is evident. This striped pattern results from the more pronounced ischemia and fibrosis that occur in this anatomical area. There is also associated glomerular sclerosis in a focal and segmental pattern in this case. (Jones' silver stain, original magnification X20).
 

From the Department of Pathology, Vanderbilt University Medical Center, Nashville, TN.
Address author queries to Agnes Fogo, MD, Department of Pathology, Vanderbilt University Medical Center, MCN C-3310, Nashville, TN 37232. E-mail:Agnes.Fogo@vanderbilt.edu
Am J Kidney Dis 36(1):E1, 2000 (available www.ajkd.org)
 Copyright 2000 by the National Kidney Foundation, Inc.

Home | Help | Feedback | Subscription | Archive | Search | Atlas Home
Home Help Feedback Subscriptions Archive Search Atlas Home