title: Severe renal tubular acidosis in a renal transplant recipient with repeated acute rejections and chronic allograft nephropathy.
abstract: Renal tubular acidosis in renal transplant recipients usually is asymptomatic and subclinical. The authors report a case of severe renal tubular acidosis manifested as muscle weakness in a renal transplant recipient. The patient received a renal transplant 30 months ago and had a history of successive episodes of acute rejection during the past 2 months. On admission, arterial blood (arterial blood pH, 7.11; pco(2), 12.8 mm Hg; and bicarbonate, 4 mEq/L [4 mmol/L]) and urine gas analysis were compatible with distal renal tubular acidosis. The graft biopsy findings showed superimposed acute rejection on chronic allograft nephropathy, and immunohistochemical staining and electron microscopic findings showed the reduced immunoactivity of H(+)ATPase pump and anion exchanger 1. The patient was treated successfully with intravenous bicarbonate and oral steroid pulse therapy. This finding suggests that rejection-related renal tubular acidosis should be considered a cause of severely affected metabolic acidosis in renal transplant recipients.
authors.affiliation: Departments of Internal Medicine, Pathology, and Anatomy, The Catholic University of Korea, Seoul, Korea. yangch@catholic.ac.kr
authors.forename: Byoung Sik
authors.initials: BS
authors.lastname: Cho
authors.forename: Hyun Sung
authors.initials: HS
authors.lastname: Kim
authors.forename: Ju Young
authors.initials: JY
authors.lastname: Jung
authors.forename: Bum Soon
authors.initials: BS
authors.lastname: Choi
authors.forename: Hyung Wook
authors.initials: HW
authors.lastname: Kim
authors.forename: Yeong Jin
authors.initials: YJ
authors.lastname: Choi
authors.forename: Chul Woo
authors.initials: CW
authors.lastname: Yang
authors.forename: Yong Soo
authors.initials: YS
authors.lastname: Kim
authors.forename: Jin
authors.initials: J
authors.lastname: Kim
authors.forename: Byung Kee
authors.initials: BK
authors.lastname: Bang
mesh_terms: D000141:Acidosis, Renal Tubular / Q000175:diagnosis* / Q000209:etiology; D000208:Acute Disease; D002908:Chronic Disease; D006084:Graft Rejection / Q000150:complications / Q000175:diagnosis*; D006801:Humans; D016030:Kidney Transplantation / Q000009:adverse effects* / Q000379:methods; D008297:Male; D008875:Middle Aged; D012008:Recurrence; D014184:Transplantation, Homologous