A 43-year-old woman developed progressive renal insufficiency while receiving cyclosporin A after live donor kidney transplantation. Despite the discontinuation of this drug and substitution with azathioprine, the renal function continued to deteriorate leading to eventual graft loss. The other causes of chronic renal failure such as allograft rejection, recurrent or 'de novo' glomerulonephritis or obstructive uropathy were not evident. There is a high frequency of acute reversible nephrotoxicity from cyclosporin A, but this patient's clinical course suggests that chronic irreversible renal failure can also occur in patients receiving this drug.
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