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Reversible renal failure in renal transplant patients receiving oral acyclovir prophylaxis
T Ahmad1, M Simmonds, A G McIver
1Department of Paediatrics, Southmead Hospital, Bristol, UK.
Insights
Acyclovir may cause acute renal failure in children after kidney transplants, even with low cyclosporin levels. Stopping acyclovir helped reverse kidney damage in these cases.
Area of Science:
- Nephrology
- Pediatric Medicine
- Pharmacology
Background:
- Post-renal transplantation complications can impact graft survival.
- Cytomegalovirus (CMV) infection prophylaxis is standard in pediatric transplant recipients.
- Drug-induced nephrotoxicity is a concern in immunosuppressed patients.
Abstract:
Two children who developed acute renal failure in the immediate post-renal transplantation period are presented. Each was immunosuppressed with cyclosporin and was also receiving oral acyclovir for prophylaxis against cytomegalovirus infection. Renal biopsy findings suggested drug toxicity. Discontinuation of acyclovir coincided with reversal of renal impairment. As cyclosporin levels were at the lower end of the therapeutic range, we believe acyclovir to be the likely causative agent.