mycophenolic-acid and Acidosis--Renal-Tubular

We report hypokalaemic quadriparesis presenting in a 43-year-old woman. Evaluation revealed hypokalaemic quadriparesis secondary to underlying distal renal tubular acidosis, also known as type 1 RTA. Four years after the diagnosis of RTA, the patient developed joint pain, and investigation revealed systemic lupus erythematosus with lupus nephritis. RTA is one of the very rare presentations of systemic lupus erythematosus. Thus, tubular dysfunction should be carefully assessed in patients with systemic lupus erythematosus. Similarly, patients with RTA should be evaluated for underlying lupus. Our patient was successfully treated with mycophenolate mofetil and steroids.

Topics: Acidosis, Renal Tubular; Acute Disease; Adult; Blood Sedimentation; Female; Humans; Hypokalemia; Lupus Erythematosus, Systemic; Muscles; Mycophenolic Acid; Paralysis; Proteinuria; Steroids; Treatment Outcome

Nephrotoxicity is one of the most common side effects of long-term immunosuppressive therapy with calcineurin inhibitors. We describe a case of distal renal tubular acidosis secondary to tacrolimus administration. A 43-year-old man with end-stage liver disease due to hepatitis C and B virus infections and alcoholic cirrhosis received a liver transplantation under immunosuppressive treatment with tacrolimus and mycophenolate mofetil. In the postoperative period, the patient developed hyperkalemic hyperchloremic metabolic acidosis, with a normal serum anion gap and a positive urinary anion gap, suggesting distal renal tubular acidosis. We excluded other causes of hyperkalemia. Administration of intravenous bicarbonate, loop diuretics, and oral resin exchanger corrected the acidosis and potassium levels. Distal renal tubular acidosis is one of several types of nephrotoxicity induced by tacrolimus treatment, resulting from inhibition of potassium secretion in the collecting duct. Treatment to correct the acidosis and hyperkalemia should be promptly initiated, and the tacrolimus dose adjusted when possible.

Topics: Acidosis, Renal Tubular; Administration, Oral; Adult; Bicarbonates; Cation Exchange Resins; Drug Therapy, Combination; Humans; Hyperkalemia; Immunosuppressive Agents; Liver Cirrhosis, Alcoholic; Liver Transplantation; Male; Mycophenolic Acid; Polystyrenes; Sodium Potassium Chloride Symporter Inhibitors; Tacrolimus; Treatment Outcome