tacrolimus and adefovir

Drug-induced renal failure is a frequent complication in the setting of ICU. Generally spoken pathomechanisms leading to drug-induced renal failure can be divided into hemodynamic effects, epithelial toxicity or crystalline nephropathy. The risk of drug-induced renal failure is increased by any form of hypovolemia (i.e. true hypovolemia or reduced effective circulating volume), older age, pre-existent renal impairment, and concomitant application of two or more nephrotoxins. This article reviews drugs most frequently responsible for renal failure in the ICU and discusses preventive measures.

Topics: Acute Kidney Injury; Adenine; Amphotericin B; Anti-Inflammatory Agents, Non-Steroidal; Antiviral Agents; Calcineurin Inhibitors; Cidofovir; Cyclooxygenase Inhibitors; Cytosine; Foscarnet; Hemodynamics; Humans; Hydroxyethyl Starch Derivatives; Immunoglobulins, Intravenous; Intensive Care Units; Kidney; Organophosphonates; Tacrolimus

Hepatitis E virus infection usually causes an acute and self-resolving hepatitis. In areas where chronic hepatitis B virus infection is prevalent, acute hepatitis E virus superinfection on chronic hepatitis B virus infection occurs sporadically. In recent years, however, chronic hepatitis E virus infection has been recognized in patients under immunosuppressant therapy. To the best of our knowledge, cases involving patients with chronic hepatitis E virus and hepatitis B virus dual infection have never been reported.. A 47-year-old Taiwanese woman who was a renal transplant recipient with chronic hepatitis B virus infection was under immunosuppressant and antiviral treatment. An episode of hepatitis B exacerbation developed due to withdrawal of antiviral treatment against advice, but the flare subsided following antiviral re-treatments. However, an episode of hepatitis exacerbation developed following removal of the renal graft because of graft failure. During the hepatitis flare, she was still under successful antiviral suppression against hepatitis B virus, while her serum samples were positive for hepatitis E virus RNA. Following the hepatitis flare, seroclearance of hepatitis B virus surface antigen developed. From then on, she was under regular hemodialysis. Five years later, another episode of mild hepatitis exacerbation occurred again with positive serum hepatitis E virus RNA. Tracing back the longitudinal serum samples, serum hepatitis E virus RNA was persistently positive throughout the course. This patient was thus recognized to have chronic hepatitis E virus and hepatitis B virus dual infection with intermittent hepatitis E exacerbations.. In areas where chronic hepatitis B virus infection is prevalent, chronic hepatitis E virus coinfection can occur in organ transplant recipients receiving immunosuppressant. Intermittent hepatitis E exacerbations may develop, interfering with the status of hepatitis B virus infection.

Topics: Adenine; Coinfection; Disease Progression; DNA, Viral; Female; Graft Rejection; Hepatitis B Surface Antigens; Hepatitis B virus; Hepatitis B, Chronic; Hepatitis E; Hepatitis E virus; Humans; Immunosuppressive Agents; Kidney Transplantation; Lamivudine; Medication Adherence; Middle Aged; Organophosphonates; Reverse Transcriptase Inhibitors; Reverse Transcriptase Polymerase Chain Reaction; Tacrolimus