title: Clinical analysis of hyperkalemic renal tubular acidosis caused by calcineurin inhibitors in solid organ transplant recipients.
abstract: OBJECTIVE
  Calcineurin inhibitor (CNI)-based immunosuppressive regimen is widely used for preventing rejection in solid organ transplantation. Hyperkalemic renal tubular acidosis (RTA) caused by CNI is uncommon and potentially underappreciated. We reported four such cases to increase awareness of this risk and to provide recommendations for its management based on our experience.
  
  
  METHODS
  Four middle-aged males underwent solid organ transplant (two kidneys, one liver, one heart) and were treated with CNI-based immunosuppressive regimen (one cyclosporine A, three tacrolimus). On post-operative day 13-35, hyperkalemic hyperchloremic non-gap metabolic acidosis developed. All patients had relatively preserved renal function, normal urine output and plasma aldosterone level. Reduction in CNI dosage was partly effective; the patient on cyclosporine A was treated with fludrocortisone, and two others temporarily switched to sirolimus (SRL).
  
  
  CONCLUSIONS
  We should alert for CNI-induced hyperkalemic RTA in transplant recipients. By CNI dosage reduction or adding low dose fludrocortisone, or temporarily switching to SRL, the prognosis of CNI-induced hyperkalemic RTA is favourable.
authors.affiliation: Department of Nephrology, The Second Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang, China.
authors.forename: W
authors.initials: W
authors.lastname: Lin
authors.affiliation: Department of Nephrology, The Second Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang, China.
authors.forename: L
authors.initials: L
authors.lastname: Mou
authors.affiliation: Department of Nephrology, The Second Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang, China.
authors.forename: H
authors.initials: H
authors.lastname: Tu
authors.affiliation: Department of Nephrology, Binjiang Branch Hospital, The Second Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang, China.
authors.forename: L
authors.initials: L
authors.lastname: Zhu
authors.affiliation: Department of Nephrology, The Second Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang, China.
authors.forename: J
authors.initials: J
authors.lastname: Wang
authors.affiliation: Department of Nephrology, The Second Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang, China.
authors.forename: J
authors.initials: J
authors.lastname: Chen
authors.affiliation: Department of Nephrology, The Second Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang, China.
authors.forename: Y
authors.initials: Y
authors.lastname: Hu
mesh_terms: D000141:Acidosis, Renal Tubular / Q000139:chemically induced*; D065095:Calcineurin Inhibitors / Q000009:adverse effects* / Q000627:therapeutic use; D006801:Humans; D007166:Immunosuppressive Agents / Q000009:adverse effects* / Q000627:therapeutic use; D016030:Kidney Transplantation / Q000379:methods; D008297:Male; D008875:Middle Aged; D066027:Transplant Recipients
chemical_list: D065095:Calcineurin Inhibitors; D007166:Immunosuppressive Agents
keywords: calcineurin inhibitor; fludrocortisone; hyperkalemic renal tubular acidosis; sirolimus; solid organ; transplantation