Tacrolimus-Induced Type IV Renal Tubular Acidosis following Liver Transplantation

Schmoyer, Christopher J.; Mishra, Suraj; Fulco, Frank

doi:10.1155/2017/9312481

Cited by 7 publications

(11 citation statements)

References 11 publications

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“…These agents cause hyperkalemic RTA by reducing aldosterone synthesis (ACE inhibitors), release (NSAIDs and heparin), or receptor binding (spironolactone, eplerenone), or through inhibition of ENaC (amiloride, trimethoprim, and pentamidine) [ 5 ]. Hyperkalemic RTA may also be caused by immunosuppressant therapy with calcineurin inhibitors (e.g., tacrolimus and ciclosporin) [ 60 – 62 ]. Calcineurin inhibitors block K + and H + secretion from the collecting duct through inhibition of basolateral Na + /K + -ATPase and Na + /K + /2Cl – cotransporter activity [ 62 , 63 ].…”

Section: Classification Of Rtamentioning

confidence: 99%

“…Hyperkalemic RTA may also be caused by immunosuppressant therapy with calcineurin inhibitors (e.g., tacrolimus and ciclosporin) [ 60 – 62 ]. Calcineurin inhibitors block K + and H + secretion from the collecting duct through inhibition of basolateral Na + /K + -ATPase and Na + /K + /2Cl – cotransporter activity [ 62 , 63 ]. Calcineurin inhibitors also suppress expression of mineralocorticoid receptors, resulting in aldosterone resistance [ 64 ].…”

Section: Classification Of Rtamentioning

confidence: 99%

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Renal Tubular Acidosis and Management Strategies: A Narrative Review

2020

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Renal tubular acidosis (RTA) occurs when the kidneys are unable to maintain normal acid−base homeostasis because of tubular defects in acid excretion or bicarbonate ion reabsorption. Using illustrative clinical cases, this review describes the main types of RTA observed in clinical practice and provides an overview of their diagnosis and treatment. The three major forms of RTA are distal RTA (type 1; characterized by impaired acid excretion), proximal RTA (type 2; caused by defects in reabsorption of filtered bicarbonate), and hyperkalemic RTA (type 4; caused by abnormal excretion of acid and potassium in the collecting duct). Type 3 RTA is a rare form of the disease with features of both distal and proximal RTA. Accurate diagnosis of RTA plays an important role in optimal patient management. The diagnosis of distal versus proximal RTA involves assessment of urinary acid and bicarbonate secretion, while in hyperkalemic RTA, selective aldosterone deficiency or resistance to its effects is confirmed after exclusion of other causes of hyperkalemia. Treatment options include alkali therapy in patients with distal or proximal RTA and lowering of serum potassium concentrations through dietary modification and potential new pharmacotherapies in patients with hyperkalemic RTA including newer potassium binders.

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Section: Classification Of Rtamentioning

confidence: 99%

Section: Classification Of Rtamentioning

confidence: 99%

Renal Tubular Acidosis and Management Strategies: A Narrative Review

2020

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“…[38] Patients with reduced bone mass were more likely to have been treated for acute rejection, and to have had greater cumulative exposure to steroids during the year preceding the measurement of their BMD. [25] The persistence of abnormal BMD in more than half of the patients raises the question whether those patients develop renal tubular acidosis [11] with subsequent bone resorption. However, the laboratory assessment in the current study did not show evidence suggestive of acid base disorder or significant differences between patients with normal BMD and those with abnormal BMD.…”

Section: Discussionmentioning

confidence: 99%

“…After transplant, liver functions are restored, but may still be counteracted by other factors such as abnormal thyroid profile, diabetes mellitus, pubertal delay, [5–9] poor postoperative ambulation, [4] and prolonged large doses immunosuppression. [10,11]…”

Section: Introductionmentioning

confidence: 99%

Bone demineralization in a cohort of Egyptian pediatric liver transplant recipients: Single center pilot study

et al. 2022

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Liver transplantation (LT) is the definitive treatment of end-stage liver disease. The long-term survival following LT spurred more interest in improving the quality of life of patients. This was a cohort study that included 23 pediatric liver transplant recipients who underwent LT due to hereditary or metabolic liver diseases. Bone health assessment was performed at their last follow up clinically (anthropometric measures), biochemically and radiologically (Dual Energy X-ray Absorptiometry [DEXA] scans). Poor bone health was defined as z-score <−1. Mean age at LT was 5.77 years (standard deviation [SD] 3.64) and 43% were males. Biliary atresia was the most common cause of end stage liver disease (35%). Mean age at follow up was 14 years (SD 5.48) and mean follow up was 8 years (SD 4.12 years). Eleven patients (48%) had poor bone health (osteopenia 22% and osteoporosis 26%). On univariate analysis, being on steroids at last follow up (odds ratio [OR] 13.2, 95% confidence interval [CI] 1.23–140.67, P = .03), weight at last follow up (OR 0.45, 95% CI 0.20–0.99, P = .04), platelets at last follow up (OR 0.98, 95% CI 0.96–s0.99, P = .02), hemoglobin at last follow up (OR 0.33, 95% CI 0.12–0.89, P = .03) were significantly associated with poor bone health. None of the variables were significant on multivariate analysis. At most recent follow up, 48% of patients demonstrated poor bone health by DEXA scans. More studies are required to evaluate predictors of poor bone health after LT in children.

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“…Hyperkalemia is the main sign of RTA. [13] This tacrolimus-induced RTA occurs in the absence of renal insufficiency, due to decreased renal tubular hydrogen ion secretion.…”

Section: Original Articlementioning

confidence: 99%

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2022

AJP

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Background: Calcineurin inhibitors (CNIs) (Tacrolimus and cyclosporine [CSA]) are immunosuppressive drugs that are administrated to prevent liver rejection after liver transplantation. Their use has led to a reduced prevalence of acute rejection and improved transplant survival. However, their use is associated with many complications, these complications include hyperkalemia nephrotoxicity, hypertension (HTN), and new-onset diabetes mellitus (NODM). This study aimed to detect the incidence of CNIs complications in Egyptian patients after liver transplantation. Study Design: A retrospective evaluation with descriptive analysis study. Patients: All adults admitted for liver transplantation from 2008 to 2016 were included in this study. Setting: The study was conducted in the Liver Transplantation Unit, Ain Shams specialized hospital, Cairo, Egypt. Results: A total of 196 patients' medical files were retrospectively reviewed to detect the incidence of CNIs complications. The tacrolimus group included 86 patients and the cyclosporin group included 92 patients. The prevalence of developing HTN was lower in the cyclosporin group as only 25% of patients developed HTN versus 40% in the tacrolimus group. The prevalence of NODM in the tacrolimus group was higher in the CSA group (33% vs. 16%). The prevalence of hyperkalemia was 52% and 28% in group tacrolimus and cyclosporin groups, respectively. The rate of nephrotoxicity in the tacrolimus group was 60% versus 48% in the cyclosporin group. Conclusions: These findings may help guide physicians in their choice of immunosuppression and underscore the need for long-term follow-up for blood sugar and potassium levels, blood pressure, and kidney function tests.

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Tacrolimus-Induced Type IV Renal Tubular Acidosis following Liver Transplantation

Cited by 7 publications

References 11 publications

Renal Tubular Acidosis and Management Strategies: A Narrative Review

Renal Tubular Acidosis and Management Strategies: A Narrative Review

Bone demineralization in a cohort of Egyptian pediatric liver transplant recipients: Single center pilot study

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