Acute renal failure caused by hyperuremic acidemia in ABO-incompatible kidney transplant maintained with cyclosporine and high-dose mizoribine: a case report.

Abstract

INTRODUCTION:

The shortage of cadaver organs has led to expansion of living donor kidney transplantations with, 30% increase among ABO-incompatible cases in Japan and the use of marginal extended donors. Herein we have reported the outcome after an ABO-incompatible kidney transplantation from an aged living-related donor who suffered from mild diabetes mellitus and hypertension.

CASE REPORT:

A 48-year-old man underwent ABO-incompatible kidney transplantation from his 76-year-old father, using anti-CD20 antibody induction, followed by cyclosporine (CsA), mycophenolate mofetil (MMF), and prednisolone. After the operation, MMF was switched to high-dose mizoribine (MZ). He was discharged from the hospital on postoperative day (POD) 28 with a serum creatinine (sCr) of 1.47 mg/dL. On POD 34 when the sCr was 8.14 mg/dL, his urine examination showed uric acid crystals with serum uric acid of 24.6 mg/dL. Biopsy findings showed no evidence of acute rejection but mild tubulointerstitial injury. Hemodialysis performed twice to reduce uric acid was accompanied by hydration. CsA/MZ was switched to tacrolims/MMF; benzbromarone, to febuxostat to treat hyperuric acidemia. On POD 58, sCr reduced to 1.75 mg/dL he was discharged. On POD 416, graft function was stable with sCr of 1.70 mg/dL.

CONCLUSION:

Common side effect of MZ is hyperuricemia which presumably caused acute renal failure of this aged marginal donor kidney.

• Authors: K Akioka, K Masuda, S Harada, T Nakamura, K Okugawa, K Nakano, Y Osaka, K Tsuchiya, H Sako
• Journal: Transplantation proceedings (Transplant Proc) Vol. 45 Issue 7 Pg. 2815-8 (Sep 2013) ISSN: 1873-2623 [Electronic] United States
• PMID: 24034056 (Publication Type: Case Reports, Journal Article)
• Copyright: Copyright © 2013 Elsevier Inc. All rights reserved.

Chemical References

• ABO Blood-Group System
• Immunosuppressive Agents
• Ribonucleosides
• mizoribine
• Cyclosporine

Topics

• ABO Blood-Group System
• Acute Kidney Injury (etiology)
• Aged
• Cyclosporine (administration & dosage, therapeutic use)
• Dose-Response Relationship, Drug
• Humans
• Hyperuricemia (complications)
• Immunosuppressive Agents (administration & dosage, therapeutic use)
• Kidney Transplantation
• Male
• Middle Aged
• Ribonucleosides (administration & dosage, therapeutic use)