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Tophaceous gout in patients with renal transplants treated with cyclosporine A
B A Baethge1, J Work, M D Landreneau
1Department of Medicine, Louisiana State University Medical Center in Shreveport.
Insights
Cyclosporine A (CyA) therapy can rapidly lead to severe tophaceous gout in kidney transplant recipients. This condition presents management challenges due to renal issues and drug interactions.
Area of Science:
- Nephrology
- Rheumatology
- Immunology
Background:
- Cyclosporine A (CyA) is a common immunosuppressant used post-transplantation.
- Hyperuricemia and gout are known potential side effects of CyA therapy.
- Renal transplantation requires careful management of immunosuppression and potential complications.
Observation:
- Four renal transplant recipients developed severe tophaceous gout after starting CyA therapy.
- Patients were on a regimen of CyA, prednisone, and diuretics.
- Three patients experienced allograft rejection episodes.
Findings:
- No patient had a prior diagnosis of gout before transplantation.
- Tophi developed within five years of the initial gout attack in all patients.
- Management was complicated by renal insufficiency, drug interactions, and toxicity.
Implications:
- Clinicians must be aware of the rapid onset of tophaceous gout in CyA-treated transplant recipients.
- Early recognition and management strategies are crucial for these complex cases.
- Understanding the link between CyA and severe gout aids in patient care and monitoring.
Abstract:
Hyperuricemia and gout have been associated with cyclosporine A (CyA) therapy in transplant recipients. We describe 4 patients who developed severe tophaceous gout after renal transplantation. All of the patients received CyA, prednisone, and diuretic therapy. Three had episodes of allograft rejection. No patient had the diagnosis of gout before transplantation. All developed tophi within 5 years of the first attack of gout. Management of these patients has been difficult due to renal insufficiency, drug interactions and toxicity. Clinicians should be aware that tophaceous gout can occur rapidly in CyA treated transplant recipients.