title: Acute renal failure caused by hyperuremic acidemia in ABO-incompatible kidney transplant maintained with cyclosporine and high-dose mizoribine: a case report.
abstract: BACKGROUND
  The shortage of cadaver organs has led to expansion of living donor kidney transplantations with, 30% increase among ABO-incompatible cases in Japan and the use of marginal extended donors. Herein we have reported the outcome after an ABO-incompatible kidney transplantation from an aged living-related donor who suffered from mild diabetes mellitus and hypertension.
  
  
  METHODS
  A 48-year-old man underwent ABO-incompatible kidney transplantation from his 76-year-old father, using anti-CD20 antibody induction, followed by cyclosporine (CsA), mycophenolate mofetil (MMF), and prednisolone. After the operation, MMF was switched to high-dose mizoribine (MZ). He was discharged from the hospital on postoperative day (POD) 28 with a serum creatinine (sCr) of 1.47 mg/dL. On POD 34 when the sCr was 8.14 mg/dL, his urine examination showed uric acid crystals with serum uric acid of 24.6 mg/dL. Biopsy findings showed no evidence of acute rejection but mild tubulointerstitial injury. Hemodialysis performed twice to reduce uric acid was accompanied by hydration. CsA/MZ was switched to tacrolims/MMF; benzbromarone, to febuxostat to treat hyperuric acidemia. On POD 58, sCr reduced to 1.75 mg/dL he was discharged. On POD 416, graft function was stable with sCr of 1.70 mg/dL.
  
  
  CONCLUSIONS
  Common side effect of MZ is hyperuricemia which presumably caused acute renal failure of this aged marginal donor kidney.
authors.affiliation: Department of Surgery, Omihachiman Community Medical Center, Omihachiman, Japan. Electronic address: kakioka@koto.kpu-m.ac.jp.
authors.forename: K
authors.initials: K
authors.lastname: Akioka
authors.forename: K
authors.initials: K
authors.lastname: Masuda
authors.forename: S
authors.initials: S
authors.lastname: Harada
authors.forename: T
authors.initials: T
authors.lastname: Nakamura
authors.forename: K
authors.initials: K
authors.lastname: Okugawa
authors.forename: K
authors.initials: K
authors.lastname: Nakano
authors.forename: Y
authors.initials: Y
authors.lastname: Osaka
authors.forename: K
authors.initials: K
authors.lastname: Tsuchiya
authors.forename: H
authors.initials: H
authors.lastname: Sako
mesh_terms: D000017:ABO Blood-Group System; D058186:Acute Kidney Injury / Q000209:etiology*; D000368:Aged; D016572:Cyclosporine / Q000008:administration & dosage / Q000627:therapeutic use*; D004305:Dose-Response Relationship, Drug; D006801:Humans; D033461:Hyperuricemia / Q000150:complications*; D007166:Immunosuppressive Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D016030:Kidney Transplantation; D008297:Male; D008875:Middle Aged; D012263:Ribonucleosides / Q000008:administration & dosage / Q000627:therapeutic use*
chemical_list: D000017:ABO Blood-Group System; D007166:Immunosuppressive Agents; D012263:Ribonucleosides; C010052:mizoribine; D016572:Cyclosporine