title: Hemolytic-uremic syndrome in association with both cyclosporine and tacrolimus.
abstract: Hemolytic-uremic syndrome (HUS) is a well-recognized complication of cyclosporine (CyA) therapy. Transplant recipients with this complication are frequently switched to tacrolimus, although this drug has also been implicated. We report a case of a renal transplant recipient who developed severe graft dysfunction due to biopsy-proven HUS after receiving CyA. Renal function and hemolytic parameters improved with discontinuation of the drug, but they deteriorated again after commencement of tacrolimus 15 days later. A second transplant biopsy demonstrated fresh lesions diagnostic of HUS. Hemolytic parameters resolved with discontinuation of tacrolimus. This is the first report of metachronous HUS being caused in a renal transplant by both CyA and tacrolimus. We therefore believe that caution should be exercised when using tacrolimus as rescue therapy in patients with CyA-induced HUS.
authors.affiliation: Department of Nephrology, Beaumont Hospital, Dublin 9, Ireland.
authors.forename: K A
authors.initials: KA
authors.lastname: Abraham
authors.forename: M A
authors.initials: MA
authors.lastname: Little
authors.forename: A M
authors.initials: AM
authors.lastname: Dorman
authors.forename: J J
authors.initials: JJ
authors.lastname: Walshe
mesh_terms: D001706:Biopsy; D016572:Cyclosporine / Q000009:adverse effects*; D004730:Endothelium, Vascular / Q000473:pathology; D011464:Epoprostenol / Q000096:biosynthesis; D005260:Female; D006463:Hemolytic-Uremic Syndrome / Q000139:chemically induced*; D006801:Humans; D007166:Immunosuppressive Agents / Q000009:adverse effects*; D007376:Interleukin-2 / Q000096:biosynthesis; D007668:Kidney / Q000473:pathology; D016030:Kidney Transplantation; D008875:Middle Aged; D010744:Phosphoric Monoester Hydrolases / Q000037:antagonists & inhibitors; D016891:Polycystic Kidney, Autosomal Dominant / Q000601:surgery; D011183:Postoperative Complications / Q000139:chemically induced*; D012008:Recurrence; D016559:Tacrolimus / Q000009:adverse effects*
chemical_list: D007166:Immunosuppressive Agents; D007376:Interleukin-2; D016572:Cyclosporine; D011464:Epoprostenol; C120817:calcineurin phosphatase; D010744:Phosphoric Monoester Hydrolases; D016559:Tacrolimus