Department of Medicine, Faculty of Medicine, Kuwait University, Safat, Kuwait City, Kuwait.
Department of Medicine, Nephrology Unit, Amiri Hospital, Ministry of Health, Kuwait City, Kuwait.
Saudi J Kidney Dis Transpl. 2022 Nov 1;33(6):824-827. doi: 10.4103/1319-2442.390260. Epub 2023 Nov 29.
Calcineurin inhibitors are potent immunosuppressive drugs in solid-organ transplantation and multiple autoimmune diseases. Their use is associated with the acute impairment of glomerular filtration and chronic interstitial fibrosis. The latter is mediated by the accumulation of matrix proteins. In this case report, we present a kidney transplant patient with chronic and progressive allograft failure that was associated with nephrocalcinosis. He did not have hypercalcemic-hypercalciuric states such as hyperparathyroidism, sarcoidosis, and hyper-vitaminosis D; normocalcemic-hypercalciuric states such as distal renal tubular acidosis, medullary sponge kidney, excessive use of high-dose loop diuretics, and beta-thalassemia; hyperphosphaturic conditions; and hyperoxaluria. Moreover, his calcifications were limited to the transplanted kidney and spared the native kidneys and extrarenal tissues, and his renal function had improved and stabilized for 6 months after discontinuation of prolonged-release tacrolimus (Advagraf), indicating a cause and an effect phenomenon. Nephrocalcinosis was suspected after ultrasonography and confirmed by computed tomography scanning. Hence, allograft nephrocalcinosis may indicate chronic tacrolimus nephrotoxicity.
钙调磷酸酶抑制剂是实体器官移植和多种自身免疫性疾病中强效的免疫抑制剂。它们的使用与肾小球滤过的急性损害和慢性间质纤维化有关。后者是由基质蛋白的积累介导的。在本病例报告中，我们介绍了一位患有慢性进行性移植物功能衰竭的肾移植患者，该患者与肾钙质沉着症有关。他没有高钙血症-高钙尿症状态，如甲状旁腺功能亢进、结节病和维生素 D 过多；低钙血症-高钙尿症状态，如远端肾小管酸中毒、海绵肾、大剂量袢利尿剂过度使用和β-地中海贫血；高磷血症；和高草酸尿症。此外，他的钙化仅局限于移植肾，而不影响原肾和肾外组织，并且他的肾功能在停用长期释放他克莫司（Advagraf）后 6 个月得到改善和稳定，表明存在因果关系。超声检查后怀疑肾钙质沉着症，并通过计算机断层扫描扫描得到证实。因此，移植物肾钙质沉着症可能提示慢性他克莫司肾毒性。
