Sathyan Sharad, Baskharoun Rawya, Perlman Alan S
1Division of Nephrology and Hypertension, New York Presbyterian Hospital-Weill Cornell, New York, NY; 2Department of Cardiology, New York Methodist Hospital, Brooklyn, NY; and 3The Rogosin Institute and The Weill Medical College of Cornell University, New York, NY.
Am J Ther. 2014 Sep-Oct;21(5):e171-4. doi: 10.1097/MJT.0b013e318274df46.
Genetic muscular disorders are known risk factors for rhabdomyolysis, which may result in acute kidney injury. Recurrent episodes of acute kidney injury can lead to chronic kidney disease and eventually end-stage renal failure. We describe a patient with chronic kidney disease that developed in the setting of recurrent rhabdomyolysis, resulting in the requirement for renal transplantation. After transplantation, the maintenance of tacrolimus trough concentrations above what is typically prescribed for standard renal transplant recipients appeared to confer protection from further episodes of rhabdomyolysis. This is consistent with previous case series that demonstrated a therapeutic benefit of the calcineurin inhibitor cyclosporine in collagen VI myopathies in the nontransplant population. This case report suggests the potential application of higher tacrolimus targets in patients who have undergone renal transplantation in the setting of recurrent rhabdomyolysis leading to end-stage renal failure.
遗传性肌肉疾病是横纹肌溶解的已知危险因素，横纹肌溶解可能导致急性肾损伤。急性肾损伤的反复发作可导致慢性肾脏病，并最终发展为终末期肾衰竭。我们描述了一名在复发性横纹肌溶解背景下发生慢性肾脏病的患者，最终需要进行肾移植。移植后，将他克莫司谷浓度维持在高于标准肾移植受者通常规定的水平，似乎能预防横纹肌溶解的进一步发作。这与之前的病例系列一致，该系列表明钙调神经磷酸酶抑制剂环孢素对非移植人群的VI型胶原肌病具有治疗益处。本病例报告提示，对于因复发性横纹肌溶解导致终末期肾衰竭而接受肾移植的患者，可能应用更高的他克莫司目标浓度。
