**6.20. Corticosteroids**

Since the early 1960's, corticosteroids were used in kidney transplantation both as maintenance agents and to treat acute rejections. [47-49]. Corticosteroids down-regulate cytokine gene expression through interference with transcription. Since they are lipophilic they first trans‐ locate into cytoplasm and bind to receptors. The steroid –receptor complex then translocates to the nucleus to bind to glucocorticoid responsive elements on DNA to regulate transcription. By dampening cytokine production they blunt the immune response generated by T cells. Long-term steroid use is associated with several adverse effects including hypertension, new onset diabetes after transplantation, osteoporosis, fractures, hyperlipidemia, growth retarda‐ tion, weight gain, avascular necrosis, cataracts, cosmetic changes, depression, and psychotic behavior. With the advent of potent maintenance and induction agents the transplant com‐ munity is now moving more and more towards steroid sparing strategies.
