mercaptopurine and Kidney-Failure--Chronic

Azathioprine-induced myelosuppression is the most important side effect observed in kidney transplantation. We report a case of severe neutropenia after kidney transplantation due to a thiopurine methyltransferase deficiency. This cause of azathioprine-induced myelotoxicity is rare, but its infectious consequences may be severe. Thiopurine methyltransferase deficiency must therefore be suspected when early and severe leukopenia occurs during azathioprine therapy. Erythrocyte thiopurine methyltransferase activity measurement confirms the diagnosis. Azathioprine and 6-mercaptopurine must afterwards be definitively avoided.

Topics: Azathioprine; Contraindications; Female; Glomerulonephritis, Membranoproliferative; Graft Rejection; Homozygote; Humans; Kidney Failure, Chronic; Kidney Transplantation; Leukopenia; Mercaptopurine; Methyltransferases; Middle Aged; Postoperative Complications; Transplantation, Homologous

In 51 patients with type 1 and 9 patients with type 2 membranoproliferative glomerulonephritis, we found a male predominance in both types, a wide age range but with younger patients having predominantly type 2 disease, and clinical presentations that varied and included the nephrotic syndrome, an abnormal urinalysis only, acute nephritis, and recurrent hematuria. Hypertension and impaired renal function at the time of first evaluation, which were present in more than one-third of the patients, presaged a poor prognosis; in most of these patients end-stage renal failure or worsening of renal function occurred. Acute nephritis at onset was also related to a deteriorating course and was especially frequent in patients with type 2 membranoproliferative glomerulonephritis. Retrospective analysis of treatment regimens, in which patients were given an average of 1 year of therapy with prednisone alone or combined with cytotoxic agents, showed no effect in patients who had progressive forms of the glomerulopathy.

Topics: Adolescent; Adult; Aged; Azathioprine; Child; Chlorambucil; Complement C3; Cyclophosphamide; Drug Therapy, Combination; Female; Glomerulonephritis; Histocytochemistry; Humans; Kidney; Kidney Failure, Chronic; Male; Mercaptopurine; Middle Aged; Prednisone; Retrospective Studies

Topics: Ambulatory Care; Azathioprine; Cyclophosphamide; Glomerulonephritis; Humans; Indomethacin; Kidney Diseases; Kidney Failure, Chronic; Mercaptopurine; Renal Dialysis

Topics: Adolescent; Adult; Arteries; Azaserine; Azathioprine; Basement Membrane; Creatine; Cryptococcosis; Dactinomycin; Epithelial Cells; Female; Fibrin; Fluorescent Antibody Technique; Follow-Up Studies; Graft Rejection; Hematuria; Humans; Immunoglobulin G; Immunoglobulin M; Immunosuppressive Agents; Kidney Failure, Chronic; Kidney Glomerulus; Kidney Papillary Necrosis; Kidney Transplantation; Male; Mercaptopurine; Pneumonia; Prednisone; Proteinuria; Thrombosis; Transplantation Immunology; Transplantation, Homologous

Topics: Autopsy; Child; Child, Preschool; Coccidioidomycosis; Cystinosis; Fanconi Syndrome; Humans; Immunosuppressive Agents; Kidney Failure, Chronic; Kidney Transplantation; Male; Mercaptopurine; Prednisone; Transplantation, Homologous

Topics: Humans; Kidney Diseases; Kidney Failure, Chronic; Kidney Transplantation; Mercaptopurine; Transplantation, Homologous