Korean Journal of Nephrology 1998;17(2):317-322.
Cyclosporine을 사용하는 신장이식 환자의 Transtubular Pitassium Gradient (TRKG)의 변화
유혜승 , 양원석 , 정영옥 , 장혜숙 , 한덕종 , 박수길
Abstract
Hyperkalemia is common in renal transplant reci- pients using cyclosporine. The mechanism of hyperka- lemia in these patients is not known but may be relat- ed to renal potassium excretion defect. In this study, we calculated TTKG as a parameter of renal tubular potassium excretion and evaluated 1) serum potassium level and TTKG in renal transplant recipients compared with normal persons, 2) relatiooship between serum potassium, TTKG, and cyclosporine level, 3) change of TTKG after renal transplantation. Thirty five patients who underwent renal tran- splantation from December 1996 to March 1997 at Asan Medical Center were enroUed. Patients who had taken medications affecting potassium excretion(eg ' diuretics, ACE inhibitor) or had history of rejection were exclud- ed. We measured serum cyclosporine level, serum and urine osmolality, serum electrolytes, urine potassium 5 times every 4 day. These parameters(except cyclo- sporine level) were also measured in 20 normal per- sons as a control. There was no significant difference in age, sex and serum creatinine between 2 groups. Serum potassium level was significantly higher in renal transplant recipients than in normal persons(5.0± 0.4mEq/L vs. 4.2±0.4mEq/L, P<0.05) whereas TTKG was lower in renal transplant recipients than in normal persons(3.0±0.3 vs. 6.0±0.1, P<0.05). Serum potassium level was negatively correlated with TTKG(r=-0.17, P= 0.03) and positively correlated with serum cyclosporine level(r=0.21, P=0.02). However, there was no correlation between spot urine potassiurn concentration and TT KG. Mean serum magnesium level of renal transplant recipient was 1.4± 0.3mEq/L(normal:1.5-2.5). No carrelation was found between serum magnesium level and potassium level or TTKG. After renal transplantation, TTKG increased pro- gressively toward that of normal subjects. (POD 04: 2.2 ±0.8 POD 08: 2.6±0.4 PO M12: 3.4±0.6 PO D16:3.7± 0.4 POI MO:3.8±0.7) In conclusion, hyperkalemia in renal transplant re- cipients using cyclosporine was related to renal pota- ssium excretion defect and was positively correlated with cyclosporine level. The defect in renal K' excretion improved progressively.
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