RESUMEN
BACKGROUND: Cyclosporine (CyA) has positively impacted on the outcome of cardiac transplantation; however, the nephrotoxicity associated with CyA has been a major drawback. METHODS: In an effort to reduce exposure to CyA and possibly alleviate its nephrotoxic effects, we undertook a therapeutic strategy to switch cardiac transplant patients with biopsy-proven CyA nephrotoxicity from azathioprine (AZA) to mycophenolate mofetil (MMF) with subsequent CyA dose reduction or elimination. RESULTS: MMF was substituted for AZA in five cardiac transplant patients (four males; mean age, 60 +/- 6 years old; average time from transplant was 7 +/- 3 years) who had biopsy proven evidence of CyA nephrotoxicity, and in whom CyA dose was reduced (3/5) or discontinued (2/5). At the time of the therapeutic intervention, four patients had an average serum creatinine of 230 +/- 62 micromol/L and one patient had just been started on haemodialysis (HD). During an average follow-up period of 42 months, the slope of the inverse serum creatinine significantly improved in three patients and continued to deteriorate in one patient. The patient on HD could be transiently taken off HD. However, he developed a severe episode of cardiac rejection requiring antirejection therapy and increase in the dose of CyA. The patient was subsequently returned back on HD. CONCLUSION: In this preliminary report, we show that AZA to MMF switch with subsequent CyA dose reduction or discontinuation may slow down the progression of kidney disease in some patients. However, the patients should be followed closely for evidence of cardiac rejection.
Asunto(s)
Azatioprina/uso terapéutico , Trasplante de Corazón , Inmunosupresores/uso terapéutico , Enfermedades Renales/prevención & control , Ácido Micofenólico/análogos & derivados , Anciano , Enfermedad Crónica , Creatinina/sangre , Ciclosporina/efectos adversos , Femenino , Humanos , Enfermedades Renales/inducido químicamente , Masculino , Persona de Mediana Edad , Ácido Micofenólico/uso terapéutico , Inducción de Remisión , Resultado del TratamientoRESUMEN
Thrombotic thrombocytopenic purpura (TTP), characterized by thrombocytopenia and microangiopathic hemolytic anemia, is a relatively rare disorder. The majority of cases have no defined causes. TTP has been reported in association with many drugs, but not with imatinib mesylate. We report a 22-year-old African-American woman who developed idiopathic hypereosinophilic syndrome. She was treated with imatinib mesylate and subsequently developed microangiopathic hemolytic anemia, thrombocytopenia, and acute renal failure. TTP was diagnosed. A kidney biopsy was performed and was diagnostic of thrombotic microangiopathy. The patient was treated with plasma exchange and hemodialysis. Her eosinophilia resolved, but she remained dialysis dependent. To our knowledge, this is the first case report of the possible association between imatinib mesylate and TTP.