M. Koc et al., Severe hyperkalemia in two renal transplant recipients treated with standard dose of trimethoprim-sulfamethoxazole, AM J KIDNEY, 36(3), 2000, pp. NIL_59-NIL_64
Hyperkalemia is a serious electrolyte disorder and is a frequent finding in
renal transplant recipients. Trimethoprim-induced hyperkalemia has been in
creasingly reported in recent years. We describe two renal transplant recip
ients who developed end-stage renal disease secondary to familial Mediterra
nean fever and presented with severe hyperkalemia secondary to the use of s
tandard dose of trimethoprim. One of the patients had potential underlying
adrenal insufficiency, which might be a contributing factor for the develop
ment of hyperkalemia. We concluded that renal transplant patients receiving
even the standard dose of trimethoprim should be monitored closely for the
development of hyperkalemia. They should be recognized as a group with inc
reased risk In regard to their concurrent renal insufficiency, concomitant
use of cyclosporine, and associated tubulointerstitial disease. Patients wi
th secondary amyloidosis are at even greater risk, and subclinical adrenal
insufficiency may be an underlying risk factor for the development of sever
e, life-threatening hyperkalemia among this group of patients. (C) 2000 by
the National Kidney Foundation, Inc.