Rescue treatment for cyclosporine-associated hemolytic-uremic syndrome with intravenous immunoglobulin.
Hemolytic-uremic syndrome (HUS) is a rare complication occurring in solid-organ and bone marrow transplant recipients treated with calcineurin inhibitors cyclosporine or tacrolimus. We report here about a 30-year-old female cadaveric renal transplant recipient receiving cyclosporine who developed HUS in the early post-transplant period. Renal allograft biopsy specimens showed the characteristic features of thrombotic microangiopathy and acute cyclosporine nephrotoxicity. Cyclosporine was discontinued and the patient was switched to tacrolimus in conjunction with plasma exchange. Unfortunately, plasma exchange was interrupted by bleeding complication resulting from placement of double-lumen catheter. Intravenous immunoglobulin (IVIG) was then administrated as an alternative therapy. Hematological resolution occurred promptly and renal function recovered uneventfully. Our presenting case suggests the beneficial effect of IVIG on cyclosporine-associated HUS.
Wen
Y K
YK
Division of Nephrology, Department of Medicine, Changhua Christian, Hospital, 135 Nansiao St., Changhua, 500, Taiwan. 45440@cch.org.tw
Chen
M L
ML
D000328:Adult; D016572:Cyclosporine / Q000009:adverse effects*; D005260:Female; D006463:Hemolytic-Uremic Syndrome / Q000139:chemically induced* / Q000473:pathology / Q000628:therapy*; D006801:Humans; D016756:Immunoglobulins, Intravenous / Q000627:therapeutic use*; D007166:Immunosuppressive Agents / Q000009:adverse effects* / Q000627:therapeutic use; D016030:Kidney Transplantation; D010951:Plasma Exchange; D016559:Tacrolimus / Q000627:therapeutic use
D016756:Immunoglobulins, Intravenous; D007166:Immunosuppressive Agents; D016572:Cyclosporine; D016559:Tacrolimus