Rangel E B, Gomes S A, Machado P G, dos Santos B F Cardoso, Pestana J O Medina, Pacheco-Silva A, Heilberg I P
Universidade Federal de São Paulo, São Paulo, SP, Brazil.
Transplant Proc. 2006 Nov;38(9):3112-5. doi: 10.1016/j.transproceed.2006.08.110.
Hyperkalemia after transplantation is a common event, occurring in up to 70% of patients. It is usually asymptomatic but sometimes manifests as muscle weakness or cardiac arrhythmias.
Case report.
At 102 days after a second cadaveric kidney transplantation, a 15-year-old boy, was admitted to the emergency room with severe muscle weakness. His examinations showed a serum potassium of 9.8 mEq/L; blood pH 7.1; serum bicarbonate 7.6 mmol/L; and creatinine 2.5 mg/dL. He was initially treated with sodium bicarbonate, calcium gluconate, and furosemide. Subsequent investigation showed hyperchloremic metabolic acidosis, urinary pH <5.5, positive urinary anion gap, reduced transtubular potassium gradient (TTKG, 1.5) and low levels of aldosterone (0.7 ng/mL), suggesting the presence of type 4 renal tubular acidosis (RTA). Other causes of hyperkalemia were excluded in the present case. Serum levels of potassium returned to normal when fludrocortisone was added to the bicarbonate supplementation. This case of severe hyperkalemic secondary to type 4 RTA after kidney transplantation only responded to the combination of alkali and mineralocorticoid therapies.
移植后高钾血症是常见事件，高达70%的患者会发生。通常无症状，但有时表现为肌肉无力或心律失常。
病例报告。
一名15岁男孩在第二次尸体肾移植术后102天因严重肌肉无力入住急诊室。检查显示血清钾9.8 mEq/L；血pH 7.1；血清碳酸氢盐7.6 mmol/L；肌酐2.5 mg/dL。最初给予碳酸氢钠、葡萄糖酸钙和呋塞米治疗。随后的检查显示高氯性代谢性酸中毒、尿pH <5.5、尿阴离子间隙阳性、肾小管钾梯度降低（TTKG，1.5）以及醛固酮水平低（0.7 ng/mL），提示存在4型肾小管酸中毒（RTA）。本病例排除了高钾血症的其他病因。在补充碳酸氢盐的基础上加用氟氢可的松后血清钾水平恢复正常。该例肾移植后因4型RTA导致的严重高钾血症仅对碱疗法和盐皮质激素疗法联合有效。
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