tacrolimus and Hyponatremia

Syndrome of inappropriate antidiuretic hormone secretion (SIADH) is an extremely rare cause of hyponatremia post-liver transplantation. A 15-year-old Japanese girl with recurrent cholangitis after Kasai surgery for biliary atresia underwent successful living donor liver transplantation. Peritonitis due to gastrointestinal perforation occurred. Hyponatremia gradually developed but improved after hypertonic sodium treatment. One month later, severe hyponatremia rapidly recurred. We considered the hyponatremia's cause as SIADH. We suspected that tacrolimus was the disease's cause, so we used cyclosporine instead, plus hypertonic sodium plus water intake restriction, which improved the hyponatremia. Symptomatic hyponatremia manifested by SIADH is a rare, serious complication post-liver transplantation.

Topics: Adolescent; Cholangitis; Diagnosis, Differential; Female; Humans; Hyponatremia; Immunosuppressive Agents; Inappropriate ADH Syndrome; Liver Transplantation; Postoperative Complications; Tacrolimus; Vasopressins

We describe the first reported case of a syndrome of inappropriate secretion of antidiuretic hormone (SIADH) induced by low-dose tacrolimus in a patient with autoimmune disease. A 41-year-old man with systemic lupus erythematosus (SLE) developed hyponatremia induced by SIADH after administration of tacrolimus (0.06 mg/kg per day). In this case, the hyponatremia promptly resolved upon withdrawal of tacrolimus. This case strongly suggests that SIADH is a potentially important complication of tacrolimus administration, irrespective of dosage, and should be borne in mind whenever the drug is used.

Topics: Adult; Humans; Hyponatremia; Immunosuppressive Agents; Inappropriate ADH Syndrome; Lupus Erythematosus, Systemic; Male; Tacrolimus; Withholding Treatment

Though tacrolimus-induced nephrotoxicity and hyperkalemia are well known, severe symptomatic hyponatremia is not commonly documented with its use. Here, we report a case of severe symptomatic hyponatremia in a renal transplant recipient on tacrolimus despite normal tacrolimus trough level. All other potential causes of hyponatremia were ruled out in this patient. This case highlights an uncommon aspect of tacrolimus nephrotoxicity, which we should keep in mind while following up a renal transplant recipient.

Topics: Adult; Humans; Hyponatremia; Immunosuppressive Agents; Kidney Diseases; Kidney Transplantation; Male; Tacrolimus

Early calcineurin inhibitor-induced neurotoxicity (ECIIN) is considered when neurological symptoms occur within 4 weeks after liver transplantation (LT). Risk factors and clinical outcome of ECIIN remain largely unknown. We sought to estimate the incidence, risk factors, and outcome of ECIIN after LT. We retrospectively evaluated 158 patients that underwent LT in a 2-year period and received immunosuppression with calcineurin inhibitors (CNI) and prednisone. ECIIN was considered when moderate/severe neurological events (after excluding other etiologies) occurred within 4 weeks after LT and improved after modification of CNI. Demographic and clinical variables were analyzed as risk factors. Twenty-eight (18%) patients developed ECIIN and the remaining 130 patients were analyzed as controls. History of pre-LT hepatic encephalopathy (OR 3.16, 95% CI 1.29-7.75, P = 0.012), post-LT hyponatremia (OR 3.34, 95% CI 1.38-9.85, P = 0.028), and surgical time >7 h (OR 2.62, 95% CI 1.07-6.41, P = 0.035) were independent factors for ECIIN. Acute graft rejection and infections were more frequent in the ECIIN group. In addition, length of stay was longer in ECIIN patients. In conclusion, pre-LT hepatic encephalopathy, surgical time >7 h, and post-LT hyponatremia are risk factors for ECIIN. Clinical complications and a longer hospital stay are associated with ECIIN development.

Topics: Acute Disease; Aged; Calcineurin Inhibitors; Female; Graft Rejection; Hepatic Encephalopathy; Humans; Hyponatremia; Immunosuppression Therapy; Immunosuppressive Agents; Liver; Liver Transplantation; Male; Middle Aged; Postoperative Complications; Retrospective Studies; Risk Factors; Tacrolimus; Time Factors

Topics: Amides; Anemia; Antihypertensive Agents; Benzazepines; Drug Administration Schedule; Drug Approval; Drug Combinations; Drug Delivery Systems; Erythropoietin; Ferrosoferric Oxide; Fumarates; Humans; Hyponatremia; Immunosuppressive Agents; Kidney Diseases; Nanoparticles; Nephrology; Renal Dialysis; Renin; Tacrolimus; Tolvaptan

This study was designed to examine the hypothesis that the nephrotoxicities caused by cyclosporin and tacrolimus might differ in respect of sodium and potassium handling.. 125 patients were studied retrospectively for the first 90 days after renal transplantation. Eighty were treated initially with cyclosporin and 45 with tacrolimus.. A serum sodium level of <135 mmol/l was present for 542/5171 (10.5%) days under tacrolimus treatment compared with 377/5486 (6.9%) days under cyclosporin treatment (P < 0.0001). Severe hyponatraemia, below 120 mmol/l, was also more prevalent under tacrolimus than cyclosporin treatment, P < 0.025. Nine patients, all receiving tacrolimus, were treated with fludrocortisone for fluid depletion and/or hyponatraemia. Serum potassium levels were higher in tacrolimus-treated patients (P < 0.0001), and subjects with hyponatraemia were more likely to experience hyperkalaemia (P < 0.0001).. Hyponatraemia and hyperkalaemia were more frequent in tacrolimus-treated subjects. Taken together with previous work showing that hyperuricaemia is more frequent with cyclosporin treatment, and hypomagnesaemia with tacrolimus treatment, these findings are consistent with qualitative differences between the nephrotoxicities of cyclosporin and tacrolimus.

Topics: Adult; Cyclosporine; Female; Follow-Up Studies; Graft Rejection; Graft Survival; Humans; Hyperkalemia; Hyponatremia; Immunosuppressive Agents; Kidney Failure, Chronic; Kidney Transplantation; Male; Middle Aged; Postoperative Care; Prevalence; Probability; Retrospective Studies; Risk Assessment; Severity of Illness Index; Tacrolimus; Transplantation Immunology; Treatment Outcome

Topics: Adult; Bone Marrow Transplantation; Female; Graft vs Host Disease; Humans; Hyponatremia; Inappropriate ADH Syndrome; Leukemia, Myelogenous, Chronic, BCR-ABL Positive; Tacrolimus; Transplantation, Homologous

Topics: Aldosterone; Creatinine; Humans; Hyponatremia; Kidney Transplantation; Kidney Tubules, Distal; Prednisolone; Renin; Sodium; Tacrolimus; Time Factors; Vasopressins