Drug related toxicity
Tacrolimus (FK506) toxicity
Reviewer: Nikhil Sangle, M.D. (see Reviewers page)
Revised: 3 September 2012, last major update September 2012
Copyright: (c) 2003-2012, PathologyOutlines.com, Inc.
See also Cyclosporine A toxicity
● Immunosuppressive drug used frequently in renal transplants, effect may be mediated by binding to FKBP12, a cytosolic protein
● FKBP12/FK506 binds to and inactivates calcineurin (a serine / threonine phosphatase), which inhibits calcium and calmodulin dependent B and T cell responses by blocking NFAT-mediated transcription
● Systemic levels of tacrolimus, if kept within a relatively narrow target window, may not be associated with nephrotoxicity (Transplant Proc 2009;41:3393)
● The presence of rejection does not rule out Tacrolimus or Cyclosporine toxicity
● Red cell exchange transfusion may be useful for severe toxicity (Pediatr Nephrol 2011;26:2245)
● Although mechanism of action is similar to cyclosporine A, mechanisms causing nephrotoxicity may differ (J Proteomics 2011;75:677)
● Reduce dosage
● Toxicity (in 1%) is similar to cyclosporin A at level of renal vascular endothelium, leading to fibrin thrombi in glomerular capillaries and afferent arterioles (Am J Surg Pathol 1996;20:306, Am J Surg Pathol 1993;17:60)
● May also cause arteriolar hyalinosis and splitting / reduplication of glomerular basement membrane
Electron microscopy images
Tubular vacuoles represent dilatations of endoplasmic reticulum and lysosomal elements
End of Kidney non-tumor > Drug related toxicity > Tacrolimus (FK506) toxicity
Ref Updated: 7/17/12
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