Puig I Marí J M, Martinez-Miralles E, Perich X, Lloveras J, Mir M, Iñigo V, Barbosa F, Orfila A, Masramón J
Nephrology Department, Hospital del Mar, Barcelona, Spain.
Transplantation. 2000 Jul 15;70(1):210-1.
Recently, a previously unrecognized posttransplant syndrome known as reflex sympathetic dystrophy syndrome of the lower limbs has emerged in patients receiving cyclosporine as immunosuppression. We describe herein this complication observed in a patient treated with tacrolimus after kidney transplantation.
A 49-year-old man received a kidney transplant from a cadaver donor and was treated with tacrolimus. Three months later, the patient complained of severe pain in the lower limbs that affected both knees and ankles. Bone scintigraphy and magnetic resonance were consistent with reflex sympathetic dystrophy syndrome.
Laboratory tests that included creatinine, glomerular filtration rate, calcium, phosphate, urate, alkaline phosphatase, and parathormone were normal or near normal. Tacrolimus levels were around 13 microg/ml. Clinical improvement appeared slowly and spontaneously during the following 3 months, without appreciable changes in the tacrolimus level.
In kidney transplant patients, tacrolimus could be a risk factor for the development of a reflex sympathetic dystrophy syndrome.
最近，在接受环孢素免疫抑制治疗的患者中出现了一种先前未被认识的移植后综合征，称为下肢反射性交感神经营养不良综合征。我们在此描述了一名肾移植后接受他克莫司治疗的患者中观察到的这种并发症。
一名49岁男性接受了尸体供者的肾移植，并接受他克莫司治疗。三个月后，患者抱怨双下肢严重疼痛，累及双膝和双踝。骨闪烁显像和磁共振成像与反射性交感神经营养不良综合征相符。
包括肌酐、肾小球滤过率、钙、磷、尿酸、碱性磷酸酶和甲状旁腺激素在内的实验室检查结果正常或接近正常。他克莫司血药浓度约为13微克/毫升。在接下来的3个月中，临床症状缓慢且自发改善，他克莫司血药浓度无明显变化。
在肾移植患者中，他克莫司可能是发生反射性交感神经营养不良综合征的一个危险因素。
