The pathogenesis of hyperchloremic metabolic acidosis associated with kidney transplantation

Batlle, Daniel; Mozes, Martin F.; Manaligod, José R.; Arruda, José A.L.; Kurtzman, Neil A.

doi:10.1016/0002-9343(81)90534-9

Cited by 71 publications

(22 citation statements)

References 25 publications

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“…The simultaneously low plasma renin levels are consistent with a defect in its secretion. Such a defect is reminiscent of that identified by Batlle et al [53] in patients with functioning kidney transplants in the precyclosporine era.…”

Section: Discussionmentioning

confidence: 66%

Clinical Course of Late-Onset Bone Marrow Transplant Nephropathy

Cohen¹,

Lawton

Moulder

et al. 1993

Nephron

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Late-onset renal insufficiency is an increasingly recognized complication of bone marrow transplantation (BMT) which occurs between 6 and 12 months after BMT. This syndrome, which has occurred in 25% of our 2-year survivors, is characterized by azotemia, hypertension, and disproportionate anemia. A minority of our subjects have had a presentation similar to hemolytic-uremic syndrome, with rapid decline in kidney function. The others have had slower declines in kidney function, without apparent ongoing hemolysis. Stabilization of function has occurred in about one third of cases. Light microscopy has shown mesangial and endothelial cell dropout with widening of glomerular capillary loops. Electron microscopy has shown a striking subendothelial expansion of the glomerular basement membrane. This syndrome is similar to acute radiation nephritis. Stabilization of kidney function has occurred in some cases, perhaps reflecting control of the blood pressure. Studies of the prevention of this condition are needed because of the frequency of its occurrence and the growing number of BMT worldwide.

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Section: Discussionmentioning

confidence: 66%

Clinical Course of Late-Onset Bone Marrow Transplant Nephropathy

Cohen¹,

Lawton

Moulder

et al. 1993

Nephron

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“…Acidosis has long been recognized as a risk factor in RTRs, and several potential causes have been suggested (26)(27)(28)(29)(30). Well known contributors to acidosis are reduced nephron mass, resulting in decreased acid excretion, and use of pharmacologic agents, such as calcineurin inhibitors, that directly influence acid-base status but also play a significant role in renal acid handling.…”

Section: Discussionmentioning

confidence: 99%

Dietary Acid Load and Metabolic Acidosis in Renal Transplant Recipients

Berg

Engberink

Brink

et al. 2012

Clinical Journal of the American Society of Nephrology

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SummaryBackground and objectives Acidosis is prevalent among renal transplant recipients (RTRs) and adversely affects cardiometabolic processes. Factors contributing to acidosis are graft dysfunction and immunosuppressive drugs. Little is known about the potential influence of diet on acidosis in RTRs. This study examined the association of metabolic acid load with acidosis and with cardiovascular risk factors in RTRs and aimed to identify dietary factors associated with acidosis.Design, participants, setting, & measurements 707 RTRs were included. Metabolic acid load was assessed by measuring 24-hour urinary net acid excretion (NAE; i.e., titratable acid + ammonium 2 bicarbonate). Acidosis was defined as serum [HCO 3 2 ] , 24 mmol/L. BP and insulin resistance, reflected by hemoglobin A1c, were among cardiovascular risk factors. Diet was assessed with food-frequency questionnaires. Linear regression analysis was applied to investigate association between NAE and acidosis and between dietary factors and acidosis.Results Mean age 6 SD was 53613 years; 57% of patients were male. Acidosis was present in 31% of RTRs. NAE was associated with acidosis (serum HCO 3 2 : b=20.61; serum pH: b=20.010; both P,0.001). Patients with high intake of animal protein (i.e., from meat, cheese, and fish) and low intake of fruits and vegetables had significantly lower serum HCO 3 2 and serum pH. No associations were observed between NAE and cardiovascular risk factors, such as hypertension and insulin resistance.Conclusions In addition to conventional factors contributing to acidosis, diet might influence acid-base homeostasis in RTRs. Higher intake of fruits and vegetables and lower animal protein intake is associated with less acidosis in RTRs.

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“…[5][6][7] However, information about the prevalence, clinical importance, and risk factors of metabolic acidosis in long-term allograft recipients is poor. In this study, prevalence of metabolic acidosis was found to be 31.8% in stable kidney allograft recipients.…”

Section: Discussionmentioning

confidence: 99%

Renal tubular acidosis in renal transplantation recipients

et al. 2010

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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.

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The pathogenesis of hyperchloremic metabolic acidosis associated with kidney transplantation

Cited by 71 publications

References 25 publications

Clinical Course of Late-Onset Bone Marrow Transplant Nephropathy

Clinical Course of Late-Onset Bone Marrow Transplant Nephropathy

Dietary Acid Load and Metabolic Acidosis in Renal Transplant Recipients

Renal tubular acidosis in renal transplantation recipients

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