Characteristic features of tacrolimus-induced lung disease in rheumatoid arthritis patients

Sasaki, Takanori; Nakamura, Wataru; Inokuma, Shigeko; Matsubara, Erika

doi:10.1007/s10067-015-2865-6

Cited by 21 publications

(10 citation statements)

References 11 publications

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“…Azathioprine and mammalian target of rapamycin inhibitors (mTOR, e.g., Sirolimus and Everolimus) are those at greater risk for pulmonary complications. A few reports suggest that Tacrolimus and Mycophenolate mofetil may also lead to lung injury [70][71][72].…”

Section: The Occurrence Of Lung Diseases After Kidney Transplantationmentioning

confidence: 99%

When kidneys and lungs suffer together

Sorino¹,

Scichilone

Negri

et al. 2018

J Nephrol

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A significant interaction between kidneys and lungs has been shown in physiological and pathological conditions. The two organs can both be targets of the same systemic disease (eg., some vasculitides). Moreover, loss of normal function of either of them can induce direct and indirect dysregulation of the other one. Subjects suffering from COPD may have systemic inflammation, hypoxemia, endothelial dysfunction, increased sympathetic activation and increased aortic stiffness. As well as the exposure to nicotine, all the foresaid factors can induce a microvascular damage, albuminuria, and a worsening of renal function. Renal failure in COPD can be unrecognized since elderly and frail patients may have normal serum creatinine concentration. Lungs and kidneys participate in maintaining the acid-base balance. Compensatory role of the lungs rapidly expresses through an increase or reduction of ventilation. Renal compensation usually requires a few days as it is achieved through changes in bicarbonate reabsorption. Chronic kidney disease and end-stage renal diseases increase the risk of pneumonia. Vaccination against Streptococcus pneumonia and seasonal influenza is recommended for these patients. Vaccines against the last very virulent H1N1 influenza A strain are also available and effective. Acute lung injury and acute kidney injury are frequent complications in critical illnesses, associated with high morbidity and mortality. The concomitant failure of kidneys and lungs implies a multidisciplinary approach, both in terms of diagnostic processes and therapeutic management.

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Section: The Occurrence Of Lung Diseases After Kidney Transplantationmentioning

confidence: 99%

When kidneys and lungs suffer together

Sorino¹,

Scichilone

Negri

et al. 2018

J Nephrol

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show abstract

“…So far, cyclophosphamide, bleomycin, carmustine, statin, everolimus, and a few others have been implicated in drug-induced NSIP/ILD. However, tacrolimus has also been shown to cause lung injury and NSIP-like changes [19]. Our patient has been on tacrolimus since her first renal transplant and it could be one of the possible causes for NSIP changes seen in our patient.…”

Section: Discussionmentioning

confidence: 75%

Metastatic Pulmonary Calcification with Coexisting Non-specific Interstitial Pneumonia: A Rare Case Report and Literature Review

Inamdar¹,

Pulinthanathu

2019

Cureus

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Patients with underlying chronic kidney disease (CKD) often have elevated serum calcium and parathyroid hormones due to compromised kidney function. We present a case of a 63-year-old female non-smoker with a surgical history of three renal transplants (at age 47, 51, and 58) along with thyroidectomy and parathyroidectomy, who came to the emergency department with complaints of a persistent dry cough and shortness of breath for the last two months. The patient had been on immunosuppressive drugs-tacrolimus, prednisolone, and mycophenolic acid-since her first renal transplant as well as on cinacalcet after parathyroidectomy (at age 54). An initial computed tomography (CT) scan demonstrated ground glass opacities in the bilateral upper lobes while bronchoscopy revealed few inflammatory cells without any fungi or bacteria. A repeat CT scan performed five days later due to rapid progression of her clinical symptoms showed worsening of ground glass opacities in the bilateral upper lobes and new nodules in the right middle and lower lung lobes. A wedge lung biopsy revealed metastatic pulmonary calcification (MPC) in the right upper lobe and non-specific interstitial pneumonia (NSIP) in the right lower lobe, confirming the co-existence of two different pathological processes most likely complicating the patient's clinical symptoms. Despite comprehensive medical therapy, the patient's symptoms progressively worsened and she is currently undergoing evaluation for both renal and lung transplants. Our case report not only presents a rare case of MPC coexisting with NSIP but also sheds light on the associated morbidity due to pulmonary symptoms in CKD patients.

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“…The almost unanimous cardiac hypertrophy and pulmonary hypertension encountered in the studied group on tacrolimus suggests a role of tacrolimus in maintaining and/or initiating cardiotoxicity [5] , [36] . While tacrolimus is believed to cause cardiac hypertrophy, a recent report describes tacrolimus induced interstitial lung disease in patients with rheumatoid arthritis as well [37] , suggesting a potential role in pulmonary hypertension.…”

Section: Discussionmentioning

confidence: 99%