If you or someone you love is living with chronic kidney disease (CKD) or kidney failure, or has had a kidney transplant, you may have heard about medications called calcineurin inhibitors (CNIs). These powerful medications help protect your kidneys and improve your long-term health. Here’s what you should know about CNIs.

What Are Calcineurin Inhibitors?

Calcineurin inhibitors are immunosuppressants—medicines that lower the activity of your immune system. That’s important because sometimes your immune system can mistakenly attack your own kidneys (as in autoimmune diseases like lupus nephritis) or a transplanted kidney (thinking it’s a foreign object).

Common CNIs include:

• Tacrolimus (Prograf),
• Cyclosporine (Neoral, Sandimmune), and
• Voclosporin (Lupkynis) – a newer option for lupus-related kidney disease.
  

These medications work by blocking a substance in the body called calcineurin, which is needed for activating immune system cells. By slowing down this immune response, CNIs help protect your kidneys from further damage.

How Do CNIs Help People with Kidney Disease?

Protecting Transplanted Kidneys

If you’ve had a kidney transplant, CNIs are essential to prevent your immune system from rejecting the new kidney. They’ve helped transplant recipients live longer and healthier lives. In fact, transplant success rates have gone up significantly thanks to these drugs.

Treating Lupus Nephritis

For people with lupus, a disease that can damage the kidneys, CNIs like voclosporin have made a big difference. Studies show that when added to standard treatment, voclosporin helps the kidneys work better and reduces the amount of protein leaking into the urine, which is a key sign of improvement.

Helping Children with Rare Kidney Disorders

In children with steroid-resistant nephrotic syndrome, where the kidneys leak protein into the urine and don’t respond to typical treatments, CNIs have helped prevent kidney failure. A 2023 study found that kids who responded to CNIs had much better long-term outcomes.

Supporting Patients After a Failed Transplant

Even if a kidney transplant eventually fails, continuing CNIs while waiting for another transplant may improve your health and success in the future. In another 2023 study, patients who stayed on these medications had better outcomes, including survival and readiness for a second transplant.

Do CNIs Have Side Effects?

Yes. Like all medications, CNIs can have side effects. Some of the more common or serious ones include:

• Kidney injury (yes, they can ironically hurt the kidneys if not monitored carefully)
• High blood pressure
• Tremors or headaches
• Higher risk of infections
• Increased blood sugar levels
  

That’s why it’s so important to have regular blood tests and check-ins with your doctor to make sure the dose is just right and to catch any problems early (UpToDate, 2023).

The Bottom Line, and What to Ask Your Doctor

Calcineurin inhibitors have changed the lives of many people living with kidney disease. Whether you’re protecting a new kidney, treating an autoimmune disease, or managing a rare kidney disorder, these medications can make a powerful difference, but they require careful monitoring and ongoing conversations with your healthcare team to keep you safe and healthy.

If you’re prescribed one of these medicines, be sure to ask your doctor:

• What symptoms should I watch for?
• How often should I get my labs checked?
• Are there other medicines or foods I should avoid?

Remember, you are your best advocate. Stay informed and stay connected with your care team.

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