NDT Advance Access published online on February 19, 2004
Nephrology Dialysis Transplantation, doi:10.1093/ndt/gfh079
© 2004 by European Renal Association - European Dialysis and Transplant Association
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1 Division of Nephrology, Mayo Clinic, Rochester, MN, USA
* To whom correspondence should be addressed. E-mail: fervenza.fernando{at}mayo.edu.
Background. Based on its success as a transplant immunosuppressor, there is intense interest in using rapamycin in the treatment of progressive glomerulopathies involving native kidneys. However, we call attention to the potential toxicity associated with the use of rapamycin in this setting. Methods. We conducted a study to examine the efficacy and safety of rapamycin in patients with progressive chronic renal failure. Eleven patients with either focal segmental glomerulosclerosis, immunoglobulin A nephropathy, membranous nephropathy or membrano-proliferative glomerulonephritis and progressive renal failure (defined as an increase in >25% of baseline serum creatinine over the last year or loss of glomerular filtration rate Results. Six patients developed acute renal failure, defined as an increase in serum creatinine Conclusions. Rapamycin can cause nephrotoxicity in some patients with chronic glomerulopathies. Whether the toxicity is solely related to rapamycin, due to the combination of proteinuria and rapamycin, or other unknown factor use is presently undetermined.
Accepted November 28, 2003
Preliminary Communication
Acute rapamycin nephrotoxicity in native kidneys of patients with chronic glomerulopathies
Abstract 
5 ml/min/year as determined by the Cockcroft-Gault formula), proteinuria 1.0 g/24 h and with a creatinine clearance of 20 ml/min/1.73 m2 were entered into a 12 month study. Patients were treated with rapamycin, starting at 5 mg/day, orally, aiming for target blood levels of 7-10 ng/dl. All patients were on treatment with an angiotensin-converting enzyme inhibitor and/or an angiotensin receptor blocker, aiming to control blood pressure 
145/90 mmHg.0.5 mg/dl (baseline: 3.2±0.9 mg/dl; peak: 5.6±1.6 mg/dl; P<0.01, paired t-test). In four patients, discontinuation of the drug resulted in improvement of renal function close to baseline levels. One patient required haemodialysis and had no subsequent recovery of renal function. In another patient, renal function recovered after discontinuation of the drug and then rapamycin was resumed at a lower dose when creatinine returned to baseline. This resulted in a second acute increase in serum creatinine that failed to return to baseline when the medication was discontinued. Four other patients had the following adverse events: skin rash, severe hypertriglyceridaemia, diarrhoea and hyperkalaemia. In none of the subjects were rapamycin levels >15 ng/dl.
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