Tacrolimus nephrotoxicity

In two women aged 37 and 69, acute and reversible tacrolimus nephrotoxicity developed after the addition of clarithromycin for an upper respiratory tract infection (76). 

Long-term follow-up (mean of 93 months) of tacroU-mus-based immunosuppression has been reported in 121 adult patients with liver transplants (10). Infections were the most common causes of deaths (17 patients out of 42), and half of them occurred during the first year after transplantation. Cardiovascular events (seven patients) or de novo malignancies (three patients) were also important causes of death. End-stage renal disease related to tacrolimus nephrotoxicity was noted in two patients who required renal transplantation At 7 years, other important adverse effects included hyperkalemia (30%) or... 

Tacrolimus nephrotoxicity has been reviewed (68) and is considered to be very similar to that described with ciclosporin. The clinical and histological characteristics of acute tacrolimus nephrotoxicity have been described from a retrospective analysis of 67 patients with renal transplants, of whom 27 developed acute nephrotoxicity, in seven of whom underljdng moderate-to-severe renal arteriosclerosis might have predisposed to tacrohmus nephrotoxicity (69). 

Gomez G, Alvarez ML, Errasti P, Lavilla FJ, Garcia N, Ballester B, Garcia I, Purroy A. Acute tacrolimus nephrotoxicity in renal transplant patients treated with clarithromycin. Transplant Proc 1999 31(6) 2250-1. 

Flaas M, Meehan SM, Josephson MA, Wit EJ, Woodle ES, Thistlethwaite JR. Smooth muscle-specific actin levels in the urine of renal transplant recipients correlation with cyclosporine or tacrolimus nephrotoxicity. Am J Kidney Dis 1999 34 69-84. 

Vincent F, Laskow DA, Neylan JF, Mendez R, Matas AJ. One-year follow-up of an open-label trial of FK506 for primary kidney transplantation. A report of the U.S. Multicenter FK506 Kidney Transplant Group. Transplantation 1996 61 1576-1581. McLaughlin GE, Abitbol CL. Reversal of oliguric tacrolimus nephrotoxicity in children. Nephrol Dial Transplant 2005 20 1471-1415. 

Shihab FS, Bennett WM,Tanner AM, AndohTF. Mechanism of fibrosis in experimental tacrolimus nephrotoxicity.Transplantation 1997 64 1829-1837. 

Zhong Z, Connor HD, Li X, Mason RP, Forman DT, Lemasters JJ,Thurman RG. Reduction of ciclosporin and tacrolimus nephrotoxicity by plant polyphenols. J Pharm Pharmacol 2006 58 1533-1543. 

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