肾移植后他克莫司与五酯胶囊合用致高血钾症1例

Hyperkalemia induced by tacrolimus combined with Wuzhi-capsule following renal transplantation: One case report

背景:肾移植患者由于免疫抑制剂的药物肝毒性,肝功能异常发生率高,对临床出现肝功能异常者,需护肝治疗。但合用护肝药必须监测免疫抑制剂浓度。目的:探讨肾移植患者他克莫司与五酯胶囊合用对他克莫司浓度及血生化的的影响。方法:回顾性分析1例以他克莫司为免疫抑制剂的肾移植患者加服及停用五酯胶囊时他克莫司浓度及肾功能、血生化变化。患者因"慢性肾小球肾炎,慢性肾功能不全"于1998-06起行血液透析治疗。2000-08行同种异体尸体肾移植,移植后免服他克莫司+吗替麦考酚酯+泼尼松。移植后4个月患者出现肝功能异常,加用联苯双酯。2010-07-25患者停用联苯双酯,改服五酯胶囊。2010-07-29患者停用五酯胶囊。结果与结论:服用他克莫司的肾移植受者,合用五酯胶囊,他克莫司血浓度显著升高。由5.3ng/L升至24.7ng/L,并合并高血钾症,停用五酯胶囊1周,他克莫司浓度由24.7ng/L降至6.1ng/L,血钾由6.4mmol/L降至4.6mmol/L。提示移植肾功能稳定的肾移植受者,在加用五酯胶囊,必须严密监测他克莫司血浓度及肝肾功能、电解质,及时调整他克莫司用量,保护移植肾功能。

BACKGROUND： Due to the hepatotoxicity induced by immunosuppressant, renal transplantation patients have high incidence of hepatic dysfunction. When they clinically have hepatic dysfunction, they are in need for hepatic protection treatment. However, the concentration of immunosuppressant must be monitored when hepatinica is added. OBJECTIVE： To explore the effect of the combination of tacrolimus and Wuzhi-capsule on tacrolimus concentration and blood biochemical changes in cases after renal transplantation. METHODS： Retrospective analysis on the tacrolimus concentration, renal function and blood biochemical changes when one case renal transplantation patient took or stopped taking Wuzhi-capsule who regarded tacrolimus as the immunosuppressant. The patient performed hemodialysis due to chronic glomerulonephritis and chronic renal insufficiency in June 1998, and received renal transplantation at August 2008. Tacrolimus ＋ mycophenolate ＋ prednisone were adopted after transplantation. Hepatic function became abnormal at 4 months after transplantation, and bifendate was added, which was substitute by Wuzhi-capsule at July 25, 2010. The medication was stopped on July 29, 2010. RESULTS AND CONCLUSION： If the renal transplantation recipients took tacrolimus, their blood tacrolimus concentration uplifted from 5.3 ng/L to 24.7 ng/L and they were diagnosed with hyperkalemia; if not, their blood tacrolimus concentration reduced from 24.7 ng/L to 6.1 ng/L and their potassium dropped from 6.4 mmol/L to 4.6 mmol/L. Stable renal transplantation recipients must have their tacrolimus blood concentration, liver and kidney function, as well as electrolytes monitored after adding Wuzhi-capsule; moreover, they should adjust the tacrolimus dosage timely so as to protect renal graft function.