Dimethylarginines as biomarkers for the kidney transplant management in methylmalonic aciduria.

Abstract

Methylmalonic aciduria (MMA) is an inborn error of metabolism associated with many complications despite treatment. Chronic renal failure is the most common problem, and patients may eventually require kidney transplant. Therefore, it is worth investigating whether living donor kidney transplant offers a better option than deceased kidney donors; and the value of novel vascular risk biomarkers in the assessment of transplanted MMA patients. We report a case of a 26-year-old man with MMA, who progressed to end-stage renal disease and received kidney transplant from a heterozygous next-of-kin living donor at 20 years of age. Although post-transplant urinary levels of methylmalonic acid decreased, this reduction was lower than previously reported for deceased donors. No episodes of metabolic decompensation were observed after transplantation. During his clinical progress, vascular complications appeared; and finally, pancreatitis was the cause of death. After kidney transplant, we evaluated novel vascular risk factors, such as asymmetric dimethylarginine (ADMA) and symmetric dimethylarginine (SDMA), which were used as early biomarkers of progression and metabolic management for this transplanted patient. This case report illustrates the disadvantage of transplantation with an allograft from a heterozygous living donor, and the utility of vascular risk biomarkers in renal transplant assessment.

• Authors: Luis Aldámiz-Echevarria, Fernando Andrade, Marta Llarena, Javier de Las Heras, María Luz Couce
• Journal: Nephrology (Carlton, Vic.) (Nephrology (Carlton)) Vol. 20 Issue 8 Pg. 576-9 (Aug 2015) ISSN: 1440-1797 [Electronic] Australia
• PMID: 26194982 (Publication Type: Case Reports, Journal Article)
• Copyright: © 2015 Asian Pacific Society of Nephrology.

Chemical References

• Biomarkers
• Immunosuppressive Agents
• symmetric dimethylarginine
• N,N-dimethylarginine
• Arginine

Topics

• Adult
• Allografts
• Amino Acid Metabolism, Inborn Errors (blood, complications, diagnosis)
• Arginine (analogs & derivatives, blood)
• Biomarkers (blood)
• Cause of Death
• Disease Progression
• Fatal Outcome
• Humans
• Immunosuppressive Agents (therapeutic use)
• Kidney Failure, Chronic (diagnosis, etiology, surgery)
• Kidney Transplantation (adverse effects, methods)
• Living Donors
• Male
• Pancreatitis (diagnosis, etiology)
• Predictive Value of Tests
• Risk Factors
• Time Factors
• Treatment Outcome