ABSTRACT
La inmunosupresión en niños con trasplante hepático, ha evolucionado con dos momentos clave: la disponibilidad de los inhibidores de calcineurina ciclosporina y tacrolimus. La inmunosupresión primaria se diseña sobre la base de un inhibidor de calcineurina como fármaco principal. Los esteroides se incluyen en la pauta de inmunosupresión primaria en la mayoría de los centros. Las pautas habituales a largo plazo consisten en ciclosporina o tacrolimus, en monoterapia a niveles inferiores a los deseados en el periodo precoz postrasplante, o en combinación con dosis bajas de esteroide. Los inhibidor e s de c a l c ineur ina induc en vasoconstricción arterial aguda y crónica que causa nefrotoxicidad, con disminución del filtrado glomerular y tubulopatía. Los niveles ensangre de ciclosporina o de tacrolimus se determinan para evaluar el estado de inmunosupresión. La edad de adolescente y adulto joven es una etapa de riesgo para el injerto por ser frecuente la omisión accidental de dosis de medicación inmunosupresora, una irregularidad que es difícil de evaluar en su extensión a pesar de una buena relación médicopaciente y frecuentes chequeos. El rechazo tiene una incidencia entre el 30 y 50% de los pacientes, entre los días 5 y 30 postrasplante.
Immunosuppression in children with liver transplantation has evolved with two key moments: the availability of calcineurin inhibitors, cyclosporine and tacrolimus. The primary immunosuppression is designed on the basis of a calcineurin inhibitor as primary drug. Steroids are included in the pr imary immunosuppression regimen in most schools. The long-term normal patterns consist of cyclosporine or tacrolimus as monotherapy to lower than desired levels in the early period aftertransplantation, or in combination with low dose steroid. Calcineurin inhibitors induce arterial vasoconstriction causing acute and chronic nephrotoxicity, with reduced glomerular filtration and tubular. Blood levels of cyclosporine or tacrolimus are determined to assess the state of immunosuppression. The age of adolescence and young adulthood is a time of risk to the graft by the accidental omission to be frequent doses ofimmunosuppressive medication, an irregularitywhich is difficult to assess its extent in spite of a good doctor-patient relationship and frequentcheckups. The rejection has an incidence between 30 and 50% of patients, between 5 and 30 aftertransplantation.
Subject(s)
Humans , Male , Female , Child , Calcineurin/administration & dosage , Calcineurin/analysis , Calcineurin , Calcineurin/pharmacology , Calcineurin , Calcineurin/therapeutic use , Immunosuppression Therapy/methods , Immunosuppression Therapy , Liver Transplantation/classification , Liver Transplantation , Cyclosporine/administration & dosage , Cyclosporine/pharmacology , Cyclosporine/toxicity , Cyclosporine , Cyclosporine/therapeutic use , Tacrolimus/administration & dosage , Tacrolimus , Tacrolimus/pharmacology , Tacrolimus/toxicity , Tacrolimus/therapeutic useABSTRACT
Objetivo: Relatar um caso de síndrome de dor óssea induzida por inibidores da calcineurina. Relato de caso: Paciente masculino de 54 anos, branco, foi que submetido a transplante renal haploidêntico e, ao fim do terceiro mês pós-transplante, apresentou dor espontânea, de forte intensidade, em joelhos, tornozelos e pés, de maneira simétrica, com incapacidade funcional, induzida por inibidores da calcineurina. O diagnóstico foi comprovado por ressonância magnética e cintilografia óssea. Evolução: Houve remissão espontânea e completa dos sintomas no fim do sexto mês após o transplante. Conclusão: A síndrome de dor osteoarticular induzida por inibidores da calcineurina é uma condição clínica incomum, mas que pode comprometer a qualidade de vida e a boa evolução do paciente transplantado. Seu diagnóstico correto deve ser feito prontamente por meio de estudos de ressonância magnética e de cintilografia óssea.
Objective: To present a case of calcineurin inhibitor-induced bone pain syndrome. Case report: A 54-year-old Caucasian male patient underwent a haploidentical kidney transplant and, at the end of the third postoperative month, developed severe, spontaneous, symmetrical pain in his knees, ankles, and feet, associated with functional impairment, induced by calcineurin inhibitors. The diagnosis was confirmed by MRI and bone scan. Evolution: The patient presented spontaneous remission of symptoms at the end of the sixth postoperative month. Conclusion: Calcineurin inhibitorinduced bone pain syndrome is an uncommon clinical condition, but it can impair the quality of life and good evolution of transplant recipients. Correct and prompt diagnosis with MRI and bone scan is recommended.