Uneventful re-treatment with cyclosporin in two cases of cyclosporin-induced haemolytic uraemic syndrome.

Key words: cyclosporin; haemolytic uraemic syndrome; day 2 was discontinued the same day, as laboratory studies revealed a Coombs-negative microangiopathic renal transplantation; thrombotic microangiopathy haemolytic anaemia (MAHA) with thrombopenia: haemoglobin decreased to 6.8 from 8.5 g/dl (D1), lactate dehydrogenase (LDH) increased to 987 from Introduction 140 IU/l (D1), very low haptoglobin (0.02), presence of schizocytes, total bilirubin increased to 83 mmol/l, platelet count decreased to 50 000 from 168 000/l (D1). Cyclosporin A (CyA)-induced haemolytic uraemic syn-There was no clinical or serological evidence of drome (HUS) has been clearly documented in many infection, and blood and urine cultures were negative. post-renal transplantation cases [1–3]. It remains a There was no evidence of disseminated intravascular serious complication of CyA therapy. The exact mech-coagulopathy (DIC). Antibody titres for cytomegalo-anism of induction of HUS by CyA, although still virus (CMV), herpes simplex and herpes zoster did unexplained, involves endothelial cell toxicity by CyA, not show any increase. which seems to be dose dependent [4]. In accordance From D3 to D8, the patient received i.v. immuno-with this hypothesis, clinical management of CyA-globulin infusion at a rate of 0.4 g/kg/day along with induced HUS generally starts with discontinuation of 5 units of fresh frozen plasma per day. On day 5, the CyA or reduction of its dose [1,5]. However, in all platelet count decreased further to 11 000 and creatin-cases where CyA was discontinued, restarting CyA ine increased to 202 mmol/l. On day 10, the patient therapy is mentioned only exceptionally. recovered almost completely from HUS (platelet count We report herein two cases of CyA-induced HUS, 115 000, haemoglobin 9.2, creatinine 112 mmol/l). CyA successfully managed by withdrawal of CyA, intraven-was reintroduced on day 20 with no similar event. ous immunoglobulin in one case and plasmapheresis in the second case. Reintroduction of CyA after recovery from HUS was uneventful. Case no. 2 A 47-year-old man who suffered from chronic pyelo-Cases nephritis underwent a 1-haplotype living related renal transplantation from his brother, on March 24, 1994. Case no. 1 Intraoperatively, the patient received 4 mg/kg i.v. CyA A 48-year-old woman who suffered from chronic pyelo-and 250 mg i.v. methylprednisolone. nephritis underwent a 1-haplotype living renal trans-The graft functioned immediately and serum creatin-plantation from her son on October 10, 1992, before ine decreased from 1321 mmol/l to 697 mmol/l on post-starting any form of renal replacement therapy. operative D2. Post-operatively, the immunosuppressive Intraoperatively, the patient received 4 …