RESUMO
Renal dysfunction in the setting of cholestatic liver disease is multifactorial but most often due to decreased kidney perfusion from intravascular volume depletion, acute tubular injury/necrosis, and hepatorenal syndrome. Drug-induced hepatotoxicity may be associated with a cholestatic injury pattern. We report a case of a 56-year-old man with a diagnosis of bile cast nephropathy, as a complication of drug-induced severe hyperbilirubinemia due to the abuse of intramuscular anabolic steroids bought on the internet to increase muscular mass for bodybuilding training. Kidney biopsy showed the histological pattern of diffuse potentially reversible tubular damage with intratubular bile casts obstructing the renal tubules. The patient developed acute kidney injury and needed dialysis treatment for 4 weeks until renal function recovered. The severity of the kidney injury and the requirement of hemodialysis observed in our patient are unique and have not been previously described. As full recovery of renal function is suspected with decreasing bilirubin levels, early recognition and treatment of the underlying disease is essential.
RESUMO
INTRODUCTION: There is an ongoing discussion as to whether monitoring of cyclosporine (CsA)-based immunosuppression with plasma levels two hours after medication intake (C2) offers clinical benefit over the measurement of CsA trough levels (C0) in patients after heart transplantation (HTx). In particular, data from long-term maintenance patients are not available. METHODS: C0 monitoring was performed during 19 months in 65 stable maintenance patients after HTx. During the following 19 months all patients were switched to C2 monitoring. During both periods biopsy proven acute rejections (BPAR), daily CsA dose, plasma creatinine, estimated creatinine clearance and blood pressure values for both periods were analysed. RESULTS: Data from 65 patients (9.2 ± 3.9 years post HTx) were included. No differences were observed for BPAR ≥2 between C0 (13 pts; 20%) and C2 (12 pts; 18.4%). C2 was associated with lower daily CsA doses (C0 208.7 mg/d vs. C2 182.3 mg/d, p <0.0001) while dose reduction over time was not different during both periods (C0 -13.3 mg/d vs. C2 -22.5 mg/d, p = 0.259). No difference was observed for blood pressure and creatinine clearance. CONCLUSION: In long term maintenance patients C2 monitoring was not associated with immediate beneficial effects on number of rejections, blood pressure levels, and renal parameters. However, patients received lower daily CsA doses.
