Hypokalemic paralysis secondary to tenofovir induced fanconi syndrome.

Tenofovir induced fanconi syndrome (FS) presenting as hypokalemic paralysis is an extremely rare complication in patients on anti-retroviral therapy. We report a 50-year-old male with acquired immunodeficiency syndrome on tenofovir-based anti-retroviral therapy who presented with acute onset quadriparesis. On evaluation, he was found to have hypokalemia with hypophosphatemia, glucosuria and proteinuria suggesting FS. He regained normal power in limbs over next 12 h following correction of hypokalemia. Ours would be the second reported case in India.

Living donor transplant options in end-stage renal disease patients with ABO incompatibility.

INTRODUCTION: The options available to CKD 5 patients with donor shortage due to incompatibilities is to either get enlisted in cadaver transplant program or opt for three other alternatives viz; ABO-incompatible transplant (ABO-I), ABO-incompatible transplant with Rituximab (ABO-R) or paired-kidney exchange transplant (PKE). At our institute we have performed ABO-I, ABO-R and PKE transplants and we are presenting the results of these transplants performed at our institution. Here, we report our experiences of living donor kidney transplantation in highly sensitized patients. OBJECTIVE: To review the options available to CKD 5 patients with incompatible donor. MATERIALS AND METHODS: Between January 2008 and June 2011, 7 PKE, 26 ABO-I and 7 ABO-R transplants were carried out at our institute. Evaluation of both the recipients and donors involved biochemical, serological and radiological investigations. In case of PKE, recipients were operated simultaneously in different operation theaters. In ABO-I splenectomy was done while in ABO-R was given. Post-transplant the recipient management protocol remained the same. Expenditure following each transplant was calculated. RESULTS: The graft and patient survival of ABO-I, ABO-R and PKE transplants 12-18 months after transplant were 78.9%:80%, 85.7%:85.7% and 100%:100%, respectively. CONCLUSIONS: The inclusion of Rituximab in the transplant protocol appears promising. The existing donor shortage could be addressed by encouraging other options like PKE. The limiting factor for ABO-R and PKE transplants is time and cost, respectively. The decision depends on the informed consent between the patient and the nephrologists.