title: Cyclosporine nephrotoxicity and early posttransplant hyperkalemia in living-donor renal recipients: report of 4 cases.
abstract: OBJECTIVE
  Hyperkalemia is an electrolyte disorder that may occur during the first few months after a renal transplant, in patients undergoing cyclosporine immunosuppression. We present our experience with cyclosporine-associated hyperkalemia in living-donor renal transplant recipients, with isolated clinically relevant hyperkalemia soon after surgery.
  
  
  METHODS
  We report 4 living-donor renal recipients with hyperkalemia soon after transplant.
  
  
  RESULTS
  Severe unexpected hyperkalemia (7.5- 9.4 mmol/L) was noted in our patients 12, 20, 22, and 34 days after transplant. The C2 cyclosporine concentration was within recommended range or slightly greater than 1200 ng/mL. The hypertonic glucose/insulin treatment along with potassium diet was without results. A reduction in daily cyclosporine dosages, along with 1- to 2-week administration of fludrocortisone was effective. The patients became normokalemic taking a standard, triple-drug immunosuppression protocol, and were discharged home with normal renal function. There were no repeat episodes of hyperkalemia in any of the patients during 12 months of follow-up.
  
  
  CONCLUSIONS
  Cyclosporine should be considered a cause of hyperkalemia in renal transplant recipients. Successful treatment with fludrocortisone confirms that transitional pseudohypoaldosteronism has a potential nephrotoxic effect of cyclosporine. We recommend close monitoring of the cyclosporine concentration and administering fludrocortisone when treating hyperkalemia in renal transplant recipients.
authors.affiliation: From the University Clinic of Nephrology, Medical Faculty, University "Ss Cyril and Methodius," R. of Macedonia.
authors.forename: Svetlana
authors.initials: S
authors.lastname: Pavleska-Kuzmanovska
authors.forename: Zivko
authors.initials: Z
authors.lastname: Popov
authors.forename: Ognen
authors.initials: O
authors.lastname: Ivanovski
authors.forename: Vesna
authors.initials: V
authors.lastname: Ristovska
authors.forename: Jelka
authors.initials: J
authors.lastname: Masin-Spasovska
authors.forename: Irena
authors.initials: I
authors.lastname: Rambabova-Busljetic
authors.forename: Ninoslav
authors.initials: N
authors.lastname: Ivanovski
mesh_terms: D000328:Adult; D000368:Aged; D065095:Calcineurin Inhibitors / Q000009:adverse effects* / Q000097:blood; D016572:Cyclosporine / Q000009:adverse effects* / Q000097:blood; D016903:Drug Monitoring; D005438:Fludrocortisone / Q000627:therapeutic use; D006801:Humans; D006947:Hyperkalemia / Q000139:chemically induced* / Q000175:diagnosis / Q000188:drug therapy; D007166:Immunosuppressive Agents / Q000009:adverse effects* / Q000097:blood; D007674:Kidney Diseases / Q000139:chemically induced* / Q000175:diagnosis / Q000188:drug therapy; D016030:Kidney Transplantation / Q000009:adverse effects / Q000379:methods*; D019520:Living Donors; D008297:Male; D011237:Predictive Value of Tests; D011546:Pseudohypoaldosteronism / Q000139:chemically induced* / Q000175:diagnosis / Q000188:drug therapy; D012307:Risk Factors; D012720:Severity of Illness Index; D013997:Time Factors; D066027:Transplant Recipients; D016896:Treatment Outcome
chemical_list: D065095:Calcineurin Inhibitors; D007166:Immunosuppressive Agents; D016572:Cyclosporine; D005438:Fludrocortisone