ABSTRACT
BACKGROUND: Hyperuricemia is a common adverse event frequently found in renal transplant recipients with mizoribine (MZ). Hyperuricemia itself will be a cause of renal dysfunction, and renal dysfunction also will be a cause of hyperuricemia simultaneously. This study investigates frequency of hyperuricemia and renal failure in renal transplant recipients treated with high-dose MZ. PATIENTS AND METHODS: From December 2007 to October 2015, there was a total of 32 living related renal transplant recipients treated with high-dose MZ. Of the 32 patients, 28 were treated with urate-lowering medications. RESULTS: One patient received allopurinol (AP) and 13 patients received benzbromarone (BB). For 6 of them, their urate-lowering medications were converted to febuxostat (FX) form AP or BB. In the remaining 14 patients, FX was administered from the beginning. In 2 cases of ABO-incompatible living related renal transplant recipients who were maintained with high-dose MZ and BB, severe hyperuricemia and acute renal failure occurred. One patient was a 48-year-old man, and his creatinine (Cr) level increased to 8.14 mg/dL and his serum uric acid (UA) was 24.6 mg/dL. Another patient was a 57-year-old man, and his Cr level increased to 3.59 mg/dL and his UA was 13.2 mg/dL. In both cases Cr and UA were improved, and no finding of acute rejection and drug toxicity was observed in graft biopsy specimens. BB was switched to FX and discontinuance or reduction of MZ was done. CONCLUSION: Combination of MZ and BB has the risk of acute renal dysfunction after renal transplantation. Latent renal dysfunction should be watched for in renal transplant recipients receiving high-dose MZ.
Subject(s)
Acute Kidney Injury/epidemiology , Acute Kidney Injury/etiology , Hyperuricemia/epidemiology , Hyperuricemia/etiology , Kidney Transplantation/adverse effects , Adult , Allopurinol/therapeutic use , Benzbromarone/adverse effects , Febuxostat/therapeutic use , Humans , Immunosuppressive Agents/adverse effects , Male , Middle Aged , Ribonucleosides/adverse effects , Ribonucleosides/therapeutic use , Transplant Recipients , Uric Acid/blood , Uricosuric Agents/adverse effectsSubject(s)
Kidney Transplantation/adverse effects , Pneumatosis Cystoides Intestinalis/diagnosis , Postoperative Complications/diagnosis , Barium , Cyclosporine/administration & dosage , Cyclosporine/blood , Cyclosporine/therapeutic use , Diabetic Nephropathies/complications , Drug Therapy, Combination , Enema , Humans , Immunosuppressive Agents/therapeutic use , Infusions, Intravenous , Kidney Failure, Chronic/etiology , Kidney Failure, Chronic/surgery , Male , Middle Aged , Tacrolimus/administration & dosage , Tacrolimus/blood , Tacrolimus/therapeutic useABSTRACT
A case with multiple liver abscess accompanied by massive portal venous gas is reported. A 61-yr-old male was admitted because of left lower abdominal pain, fever, and diarrhea. Abdominal x-ray examination demonstrated multiple branching lucencies in the liver. Computed tomography revealed multiple liver abscesses and massive gas in the portal system as well as a thickened wall of the sigmoid colon. Enema study using contrast medium revealed a perforation of the sigmoid colon with diverticulitis. The outcome was favorable after sigmoid colectomy in addition to intensive treatment with antibiotics. Bacteroides fragilis, which produces gas (H2 and NH3) by fermentation, was isolated not only from the resected specimen but also from blood samples. Although the presence of portal venous gas is a sign of poor prognosis in patients with intestinal infectious diseases, the sensitive detection of hepatic portal venous gas by computed tomography and the appropriate treatment may improve the patient's prognosis.