[Sodium-losing nephropathy caused by tacrolimus after allogeneic hematopoietic stem cell transplantation].
A 39-year-old woman (Case 1) and a 57-year-old woman (Case 2) underwent allogeneic bone marrow transplantation for acute lymphoblastic leukemia and follicular lymphoma, respectively. Both patients had received tacrolimus orally for treatment of or prophylaxis against graft-versus-host disease. Seventeen months (Case 1) and 2 months (Case 2) post-transplantation, when the trough level of tacrolimus was maintained around 10 ng/ml, the serum sodium levels of Cases 1 and 2 decreased to 123.5 mEq/l and 125.6 mEq/l, respectively. Urinary sodium excretions increased to 186.8 mEq/day and 375.7 mEq/day, respectively. Sodium-losing nephropathy due to tacrolimus was diagnosed, and reducing the dose of tacrolimus with no other intervention resulted in resolution of the hyponatremia. Although sporadic kidney transplantation cases with sodium-losing nephropathy due to tacrolimus have been reported, no prior cases with this complication after hematopoietic stem cell transplantation (HSCT) have been reported. Sodium-losing nephropathy should be recognized as one of the renal toxicities of tacrolimus in HSCT as well as kidney recipients.
Division of Hematology, Department of Medicine, Keio University School of Medicine.
Sayako
S
Yuda
Takehiko
T
Mori
Jun
J
Kato
Yuya
Y
Koda
Sumiko
S
Kohashi
Taku
T
Kikuchi
Masuho
M
Saburi
Shinichiro
S
Okamoto
D000328:Adult; D005260:Female; D006086:Graft vs Host Disease; D018380:Hematopoietic Stem Cell Transplantation / Q000379:methods; D006801:Humans; D007166:Immunosuppressive Agents / Q000009:adverse effects* / Q000627:therapeutic use; D007674:Kidney Diseases / Q000209:etiology*; D012964:Sodium / Q000378:metabolism*; D016559:Tacrolimus / Q000009:adverse effects* / Q000627:therapeutic use; D014184:Transplantation, Homologous / Q000379:methods
D007166:Immunosuppressive Agents; D012964:Sodium; D016559:Tacrolimus