title: Renal tubular acidosis secondary to FK506 in living donor liver transplantation: a case report.
abstract: FK506 is an immunosuppressant that is thought to be less nephrotoxic than cyclosporine A. However, complications due to renal tubular acidosis (RTA) have recently been reported. We report a case of RTA secondary to FK506 administration in liver transplantation. A 6-month-old girl was treated with FK506 after undergoing living donor liver transplantation for fulminant hepatitis. On postoperative day 17, she demonstrated hyperkalaemia and metabolic acidosis; she was diagnosed to have hyperkalaemic distal RTA with aldosterone deficiency (type IV). Intravenous sodium bicarbonate and furosemide, and intrarectal calcium polystyrenesulfonate were administered to correct the acidosis and promote potassium secretion. Thereafter, the FK506 concentration in whole blood gradually decreased, and the hyperkalaemia and metabolic acidosis following RTA improved. RTA is one type of nephrotoxicity induced by FK506, and it is reversible in mild cases when appropriately treated. The mechanism of RTA induced by FK506 has not yet been clearly elucidated. Surgeons and physicians should therefore be aware of the potential for RTA to occur with FK506 after any organ transplantation. The treatment for acidosis and hyperkalaemia should be started as soon as RTA is diagnosed, and the dosage of FK506 should also be reduced if possible.
authors.affiliation: Department of Pediatric Surgery, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan. ogita@pedsurg.med.kyushu-u.ac.jp
authors.forename: Keiko
authors.initials: K
authors.lastname: Ogita
authors.forename: Narito
authors.initials: N
authors.lastname: Takada
authors.forename: Tomoaki
authors.initials: T
authors.lastname: Taguchi
authors.forename: Sachiyo
authors.initials: S
authors.lastname: Suita
authors.forename: Yuji
authors.initials: Y
authors.lastname: Soejima
authors.forename: Taketoshi
authors.initials: T
authors.lastname: Suehiro
authors.forename: Mitsuo
authors.initials: M
authors.lastname: Shimada
authors.forename: Yoshihiko
authors.initials: Y
authors.lastname: Maehara
mesh_terms: D000141:Acidosis, Renal Tubular / Q000139:chemically induced* / Q000188:drug therapy / Q000503:physiopathology; D004359:Drug Therapy, Combination; D005260:Female; D005500:Follow-Up Studies; D005665:Furosemide / Q000008:administration & dosage; D006801:Humans; D007223:Infant; D016031:Liver Transplantation / Q000009:adverse effects* / Q000379:methods; D019520:Living Donors; D018570:Risk Assessment; D012720:Severity of Illness Index; D017693:Sodium Bicarbonate / Q000008:administration & dosage; D016559:Tacrolimus / Q000009:adverse effects* / Q000627:therapeutic use; D014181:Transplantation Immunology; D016896:Treatment Outcome
chemical_list: D005665:Furosemide; D017693:Sodium Bicarbonate; D016559:Tacrolimus