Type 4 renal tubular acidosis in a kidney transplant recipient.
We report a case of a 66-year-old diabetic patient who presented with muscle weakness 2 weeks after kidney transplantation. Her immunosuppressive regimen included tacrolimus, mycophenolate mofetil, and steroids. She was found to have hyperkalemia and normal anion gap metabolic acidosis. Tacrolimus levels were in therapeutic range. All other drugs such as beta blockers and trimethoprim - sulfamethoxazole were stopped. She did not respond to routine antikalemic measures. Further evaluation revealed type 4 renal tubular acidosis. Serum potassium levels returned to normal after starting sodium bicarbonate and fludrocortisone therapy. Though hyperkalemia is common in kidney transplant recipients, determining exact cause can guide specific treatment.
Department of Nephrology, Father Muller Medical College, Kankanady, Mangalore, Karnataka, India. Electronic address: drmjkulkarni@gmail.com.
Manjunath
M
Kulkarni
D000141:Acidosis, Renal Tubular / Q000175:diagnosis / Q000628:therapy*; D000368:Aged; D005260:Female; D006801:Humans; D006947:Hyperkalemia / Q000175:diagnosis / Q000628:therapy; D007166:Immunosuppressive Agents / Q000627:therapeutic use*; D016030:Kidney Transplantation; D016896:Treatment Outcome
D007166:Immunosuppressive Agents
Hyperkalemia; Metabolic acidosis; Renal tubular acidosis