Subject(s)
Calcium/blood , Graft Rejection/drug therapy , Kidney Transplantation , Magnesium/blood , Tacrolimus/adverse effects , Tetany/chemically induced , Graft Rejection/blood , Humans , Immunosuppressive Agents/administration & dosage , Immunosuppressive Agents/adverse effects , Male , Middle Aged , Tacrolimus/administration & dosage , Tetany/blood , Tetany/diagnosisABSTRACT
Mycophenolate (MMF) has arisen as an important addition in the immunosuppression armamentarium. GI disturbances (diarrhea) and bone marrow suppression are its main side effects requiring dose reduction or even withdrawal. The mechanism of diarrhoea is unknown, although some theories have been postulated. We evaluated three of our patients on MMF who came to us with chronic diarhoea. Their evaluation consisted of CBC, stool routine examination, stool culture, endoscopy and biopsy. Histopathologic examination in all three cases showed villous atrophy. All of them improved with discontinuation of MMF and addition of folic acid suggesting that diarrhoea was related to MMF. Since this complication is seen in only a few cases, we can hypothesize that it may be due to lower levels of the enzyme inosine monophosphate dehydrogenase (IMPDH)--the site of action of MMF.
Subject(s)
Diarrhea/chemically induced , Immunosuppressive Agents/adverse effects , Microvilli/pathology , Mycophenolic Acid/analogs & derivatives , Adult , Biopsy , Diarrhea/drug therapy , Female , Folic Acid/therapeutic use , Humans , IMP Dehydrogenase/drug effects , Immunosuppression Therapy/adverse effects , Immunosuppression Therapy/methods , Male , Middle Aged , Mycophenolic Acid/adverse effects , Treatment OutcomeABSTRACT
Kidney failure is the principal cause of death in scleroderma and accounts for at least 50% of deaths in this disease. Management of scleroderma-related end-stage renal disease requires some form of renal replacement therapy. Survival up to 18 months has been reported in one patient on continuous ambulatory peritoneal dialysis. Surviving for more than 1 year on automated peritoneal dialysis has not been reported. We report a patient with scleroderma-related end-stage renal disease treated with automated peritoneal dialysis with steady state control of uremia and hypertension at 18 months of follow-up.
