Çağlayan Feyza Bayraktar, Koç Yener, Baştürk Taner, Hasbal Barış, Sakacı Tamer, Ahbap Elbis, İslam Mahmut, Nazif Perin, Ünsal Abdulkadir
Department of Nephrology, Şişli Hamidiye Etfal Training and Research Hospital, İstanbul, Turkey.
Sisli Etfal Hastan Tip Bul. 2018 Mar 21;52(4):310-312. doi: 10.14744/SEMB.2017.75436. eCollection 2018.
Although more common with tacrolimus, it is known that calcineurin inhibitors may induce the development of electrolyte disorders such as hyponatremia and hyperkalemia by causing a hyporeninemic hypoaldosteronism-like syndrome. We present a 32-year-old female renal transplant patient who admitted to clinic with hyponatremia and hyperkalemia. Normal anion gap metabolic acidosis and renal tubular dysfunction were detected and after other reasons were excluded, it was considered as electrolyte disorder due to tacrolimus. No response was detected after tacrolimus conversion to everolimus and considering tubular dysfunction due to aldosterone resistance, we initiated fludrocortisone therapy and electrolyte disorders rapidly improved. Fludrocortisone therapy should be considered when hyponatremia and/or hyperkalemia due to tacrolimus are detected in renal transplant patients.
虽然钙调神经磷酸酶抑制剂诱发电解质紊乱（如低钠血症和高钾血症）更常见于他克莫司，但已知这类药物可通过引发一种低肾素性低醛固酮血症样综合征来导致电解质紊乱。我们报告了一名32岁的女性肾移植患者，她因低钠血症和高钾血症前来就诊。检测到正常阴离子间隙代谢性酸中毒和肾小管功能障碍，在排除其他原因后，考虑为他克莫司所致的电解质紊乱。将他克莫司转换为依维莫司后未发现疗效，鉴于存在醛固酮抵抗导致的肾小管功能障碍，我们开始使用氟氢可的松治疗，电解质紊乱迅速改善。肾移植患者若检测到因他克莫司导致的低钠血症和/或高钾血症，应考虑使用氟氢可的松治疗。
