mycophenolic-acid and Ascites

Gaucher disease (GD) is a rare autosomal recessive inherited, lysosomal storage disoder that involves liver, spleen, lung, bone, bone marrow even central nervous. However, GD associated membranoproliferative glomerulonephritis (MPGN) is seldom reported.. Here we described a case of 35-year-old man suffering from GD with hepatosplenomegaly, ascites, bone destruction, myelofibrosis and MPGN. Renal biopsy revealed MPGN and Gaucher cells presented in the glomeruli capillaries. β-glucosidase activity was 1.95nmol/1 h/mg and gene detection demonstrated that one homozygous pathogenic variant Leu483Pro in GBA. He received the treatment of oral prednisone and mycophenolate mofetil and his ascites and renal outcomes had been significantly improved.. Therapy of prednisone and mycophenolate mofetil may be an optional choice for patients with Gaucher disease who have no opportunity to use enzyme treatment.

Topics: Adult; Ascites; Gaucher Disease; Glomerulonephritis, Membranoproliferative; Humans; Male; Mycophenolic Acid; Prednisone

Common side effects of mycophenolate mofetil (MMF) are diarrhea, leukopenia, and infectious complication. The polymorphisms of enzymes affecting MMF clearance could be related to MMF toxicity, and in vitro study revealed that high MMF levels might cause endothelial dysfunction. A 7-year-old Korean male with end-stage renal disease on peritoneal dialysis due to mesangial proliferative glomerulonephritis received a kidney transplantation (KT) from a deceased donor, and immunosuppressive medications including MMF, tacrolimus, and methylprednisolone were started after KT. The patient developed oliguria immediately after surgery, and therapeutic plasmapheresis was initiated with continuous renal replacement therapy for the possibility of graft dysfunction and nephrotic syndrome relapse. Renal function recovered 4 days later, but the patient developed ascites. Diagnostic paracentesis revealed findings that were interpreted as uncomplicated ascites in cirrhosis, not of renal origin. Abdominal ultrasonography showed increased parenchymal echogenicity without cirrhotic change in the liver. Based on a case report and differential diagnosis, we replaced MMF with azathioprine, and 4 weeks later a sudden increment in urine output was detected. Eleven months after KT, the patient is free from ascites. The

Topics: Ascites; Azathioprine; Child; Humans; Immunosuppressive Agents; Kidney; Kidney Transplantation; Male; Mycophenolic Acid

Topics: Adult; Anticoagulants; Ascites; Hepatic Veno-Occlusive Disease; Humans; Immunosuppressive Agents; Liver Cirrhosis; Liver Transplantation; Male; Mycophenolic Acid

BACKGROUND Patients with massive ascites (MA) after liver transplantation (LT, defined here as daily ascitic drainage more than 1000 ml per day for more than 7 days after liver transplantation) are at increased risks of infection, hypoalbuminemia, graft loss, and even mortality. The aim of this retrospective cohort study was to investigate the effects of somatostatin on patients with MA after LT. MATERIAL AND METHODS Twenty-eight patients with liver cirrhosis or hepatocellular carcinoma who underwent LT complicated by MA postoperatively were included. Ten participants were receiving somatostatin therapy. The postoperative course and adverse drug effects were investigated. Daily postoperative ascitic drainage and urine output were also recorded and compared to those in the non-somatostatin group. RESULTS The somatostatin group had significantly less ascites drainage after LT compared to the non-somatostatin group (p=0.002). Urine output was significantly increased after somatostatin administration (p<0.001). No serious adverse effects influencing graft function or fatal complications occurred after somatostatin therapy. CONCLUSIONS Somatostatin treatment is beneficial for the management of MA after liver transplantation.

Topics: Adrenal Cortex Hormones; Adult; Aged; Ascites; Drug Therapy, Combination; Female; Humans; Immunosuppressive Agents; Liver Transplantation; Male; Middle Aged; Mycophenolic Acid; Postoperative Complications; Retrospective Studies; Somatostatin; Tacrolimus; Treatment Outcome

Topics: Adult; Ascites; Chronic Disease; Cyclophosphamide; Female; Humans; Lupus Erythematosus, Systemic; Mycophenolic Acid; Peritonitis; Prednisolone; Severity of Illness Index; Tacrolimus; Tomography, X-Ray Computed; Treatment Outcome

Mycophenolic acid (MPA), either given as an ester pro-drug or as an enteric-coated sodium salt, is the most commonly prescribed anti-proliferative immunosuppressive agent used following organ transplantation and widely applied in immune-mediated diseases. Clinicians are well aware of common adverse reactions related to MPA treatment, in particular diarrhea, leukopenia and infections. Here we report a case of severe, persistent ascites associated with MPA treatment. The otherwise unexplained and intractable ascites, requiring repeated paracenteses for more than 8 months, rapidly ceased with stopping the MPA treatment. To our knowledge this is the first case of severe ascites associated with MPA treatment reported in the scientific literature.. A 45-year old female with type 1 diabetes mellitus received a simultaneous kidney-pancreas transplant. The surgery was uneventful. However, post-operatively she developed severe transudative ascites requiring in total more than 40 paracenteses treatments draining in the average 2.8 l of ascites fluid. The ascites formation persisted despite exclusion of a surgical complication, fully functioning kidney and pancreas allografts, lack of any significant proteinuria, normalization of circulating albumin levels, intensive use of diuretics and deliberate attempts to increase the intervals between the paracentesis treatments. Various differential diagnoses, including infectious, hepatic, vascular and cardiac causes were ruled out. Nine months after surgery enteric-coated mycophenolate sodium was switched to azathioprine after which ascites completely resolved. When mycophenolate was recommenced abdominal fullness and weight gain reoccurred. The patient had to be switched to long-term azathioprine treatment. More than 1 year post-conversion the patient remains free of ascites.. MPA is the most widely used antimetabolite immunosuppressive agent. We suggest to consider MPA treatment in the differential diagnosis of severe and unexplained ascites in transplant and non-transplant patients.

Topics: Ascites; Diabetes Mellitus, Type 1; Diagnosis, Differential; Exocrine Pancreatic Insufficiency; Female; Humans; Immunosuppressive Agents; Kidney Failure, Chronic; Kidney Transplantation; Middle Aged; Mycophenolic Acid; Pancreas Transplantation; Paracentesis; Postoperative Complications; Treatment Outcome; Withholding Treatment

Topics: Abdomen; Abdominal Pain; Acute Kidney Injury; Administration, Intravenous; Adult; Anti-Inflammatory Agents; Ascites; Asthenia; Contrast Media; Creatinine; Disease Progression; Edema; Enzyme Inhibitors; Female; Humans; Jejunum; Lupus Erythematosus, Systemic; Methylprednisolone; Mycophenolic Acid; Prednisone; Tomography, X-Ray Computed; Ultrasonography; Vomiting

Gross ascites is a rare presentation of lupus. Ascites in lupus may be due to lupus peritonitis or secondary to one of the complications including nephrotic syndrome. The ascites due to lupus peritonitis has been described as exudative with a serum-ascites albumin gradient (SAAG) below 11 g/L, unless associated with nephrotic syndrome. We report an unusual case of lupus ascites in a 23-year-old woman who presented with acute painless gross ascites with no constitutional, skin or musculoskeletal symptoms of a lupus flare. The ascites was a transudate with SAAG above 11 g/L with no associated nephrotic syndrome. She was treated with corticosteroids, mycophenolate mofetil and diuretics with a good response and no recurrence of her ascites.

Topics: Acute Disease; Ascites; Diuretics; Drug Therapy, Combination; Female; Follow-Up Studies; Glucocorticoids; Humans; Immunosuppressive Agents; Lupus Erythematosus, Systemic; Mycophenolic Acid; Peritonitis; Tomography, X-Ray Computed; Young Adult

Encapsulating peritoneal sclerosis is a rare, but potentially lethal, complication of peritoneal dialysis. Treatment of patients with encapsulating peritoneal sclerosis is controversial. Conservative treatment carries a poor outcome, and immunosuppressive drugs are now used frequently. Most commonly, these immunosuppressive regimens include steroids with or without azathioprine or cyclosporine. Mycophenolate mofetil is a reversible DNA synthesis inhibitor that frequently replaces azathioprine in renal transplantation because of its improved immunosuppressive potency and better side-effect profile. We report 3 cases of encapsulating peritoneal sclerosis in continuous ambulatory peritoneal dialysis patients for which an association of prednisone and mycophenolate mofetil significantly modified the evolution of the disease. All 3 patients showed significant improvement within a month and are still alive more than 2 years after the diagnosis of encapsulating peritoneal sclerosis. None experienced a relapse or abdominal symptoms, and body weights are stable. This is the first report of 3 cases of successful treatment of patients with encapsulating peritoneal sclerosis with prednisone and mycophenolate mofetil.

Topics: Adult; Anti-Inflammatory Agents; Ascites; Ascitic Fluid; Candida glabrata; Candidiasis; Female; Fibrosis; Humans; Immunosuppressive Agents; Intestinal Obstruction; Intestine, Small; Middle Aged; Mycophenolic Acid; Peritoneal Dialysis, Continuous Ambulatory; Peritoneal Diseases; Peritoneum; Peritonitis; Prednisone; Sclerosis; Staphylococcus epidermidis