Renal tubular acidosis after kidney transplantation--incidence, risk factors and clinical implications

Keven, Kenan; Öztürk, Ramazan; Şengül, Şule; Kutlay, Sim; Ergun, Ihsan; Ertürk, Şehsuvar; Erbay, Bülent

doi:10.1093/ndt/gfl714

Cited by 47 publications

(61 citation statements)

References 23 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Type 1 classic distal RTA has been reported more frequently in kidney recipients. 2,3,5,[8][9][10] Similarly, in this study, we observed that the presence of distal RTA was higher compared with other types of RTA.…”

Section: Discussionsupporting

confidence: 77%

“…1 Particularly, in the early posttransplant period, it is frequent because of acute rejection, suboptimal allograft function, calcineurin inhibitor (CNI) nephrotoxicity, and ischemic tubular dysfunction. 2 Type 2 (proximal) RTA, the common form of RTA, is characterized by the decrement of bicarbonate reabsorption in proximal tubule because of the toxic effects of CNIs or persisting hyperparathyroidism. RTA might completely improve during the first 6 months after transplantation because tubular damage and hyperparathyroidism resolves.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Renal tubular acidosis in renal transplantation recipients

et al. 2010

View full text Add to dashboard Cite

Aim: We aimed to investigate the prevalence, type, and possible risk factors of renal tubular acidosis (RTA) in Turkish patients with renal transplantation. Patients and method: The study included 66 adult renal transplantation recipients. We recorded the parameters of venous blood gas analysis including serum pH value, serum bicarbonate (HCO 3 ) concentration, presence of metabolic acidosis, which was defined as low HCO 3 (<22 mEq/L), and serum pH value (<7.35) together, and base excess and urine pH at the last follow-up. Creatinine clearance was determined from 24-hour collected urine samples. RTA was defined to be metabolic acidosis with normal serum anion gap and positive urine anion gap. Results: Mean age of 66 patients was 37.0 ± 10.4 years; 48 of 66 patients were male. RTA was found in 14 (21.2%) patients. Considering for differential diagnosis of RTA, 4 patients had type 2 RTA and 10 had type 1 RTA. On the contrary, type 4 RTA was observed in no patients. Creatinine clearance was meaningfully lower in acidosis group than in those of the nonacidosis group (55.16 ± 23.27 vs. 71.06 ± 28.14 mL/min; p = 0.028). HCO 3 was correlated with hemoglobin level (r = 0.423, p = 0.001) and creatinine clearance (r = 0.262, p = 0.034). It was inversely correlated with cyclosporine A (CsA) level (r = −0.499, p = 0.035). Conclusion: RTA is a common complication after kidney transplantation. It is related with low creatinine clearance, low hemoglobin level, and high CsA level. Particularly, the value of creatinine clearance is lower and the possibility of RTA is higher.

show abstract

Section: Discussionsupporting

confidence: 77%

Section: Introductionmentioning

confidence: 99%

Renal tubular acidosis in renal transplantation recipients

et al. 2010

View full text Add to dashboard Cite

show abstract

“…The use of tacrolimus is often limited by many side effects such as tremor, hemolytic-uremic syndrome, arterial hypertension, hyperlipidemia, and a higher incidence of new-onset diabetes mellitus. Despite these adverse side effects, FK506 can also be nephrotoxic, causing reduced glomerular filtration rate (GFR) and distal renal tubular acidosis (dRTA), which are strongly restrictive for continuing the drug (21,37,39).Several studies in renal organ transplant patients have observed a significant correlation between dRTA and tacrolimus treatment (22,27,44). In addition, the prevalence of RTA in renal transplant recipients with a functioning graft has been associated with treatment with calcineurin inhibitors such as FK506 (22, 44).…”

mentioning

confidence: 99%

“…Several studies in renal organ transplant patients have observed a significant correlation between dRTA and tacrolimus treatment (22,27,44). In addition, the prevalence of RTA in renal transplant recipients with a functioning graft has been associated with treatment with calcineurin inhibitors such as FK506 (22, 44).…”

mentioning

confidence: 99%

The calcineurin inhibitor FK506 (tacrolimus) is associated with transient metabolic acidosis and altered expression of renal acid-base transport proteins

Mohebbi

Mihailova

Wagner

2009

American Journal of Physiology-Renal Physiology

View full text Add to dashboard Cite

Calcineurin inhibitors like FK506 (tacrolimus) are routinely used for immunosuppression following transplantation. Its use is limited by many side effects, including renal tubular acidosis (RTA), mainly of the distal type. In this study, rats were treated with FK506 and at baseline (after 9 days) systemic acid-base status was similar to that in control animals. However, FK506-treated rats given NH(4)Cl in the drinking water for 2 days developed a more severe metabolic acidosis than control animals. Urine pH was more alkaline, but net acid excretion was normal. After 7 days of acid load, all differences related to acid-base homeostasis were equalized in both groups. Protein abundance of type IIa Na-P(i) cotransporter, type 3 Na(+)/H(+) exchanger, and electrogenic Na(+)-bicarbonate cotransporter, and both a4 and B2 subunits of the vacuolar H(+)-ATPase were reduced under baseline conditions, while induction of metabolic acidosis enhanced protein abundance of these transporters in FK506-treated animals. In parallel, protein expression of AE1 was reduced at baseline and increased together with pendrin during NH(4)Cl loading in FK506 rats. Protein abundance of the Na(+)-bicarbonate cotransporter NBCn1 was reduced under baseline conditions but remained downregulated during metabolic acidosis. Morphological analysis revealed an increase in the relative number of non-type A intercalated cells in the connecting tubule and cortical collecting duct at the expense of principal cells. Additionally, subcellular distribution of the a4 subunit of the vacuolar H(+)-ATPase was affected by FK506 with less luminal localization in the connecting tubule and outer medullary collecting duct. These data suggest that FK506 impacts on several major acid-base transport proteins in the kidney, and its use is associated with transient metabolic acidosis and altered expression of key renal acid-base transport proteins.

show abstract

“…Type IV RTA can also been seen in patients with a renal transplant (225). This could be due to either an immune mediated mechanism or it could be related to medications used for the treatment of rejection.…”

Section: Acquiredmentioning

confidence: 99%