Immunosuppressive drugs and the gastrointestinal tract in renal transplant patients.

Gastrointestinal (GI) discomfort is common after renal transplantation and can be caused by the use of various immunosuppressive drugs. GI symptoms affect the quality of life, lead to an impaired graft survival and an increased mortality. Moreover, diseases and disturbances of the GI tract also affect the pharmacokinetics of immunosuppressive drugs.

Delayed trough level measurement with the use of prolonged-release tacrolimus.

Trough concentrations of prolonged-release tacrolimus are usually measured at 24 h after taking the drug in the morning. It is impractical to measure these trough concentrations in patients who visit the outpatient clinic in the afternoon. Trough concentrations obtained in the afternoon may also be suitable for estimating the 24-h exposure.

Treatment satisfaction in renal transplant patients taking tacrolimus once daily.

Background: Adherence to immunosuppressive therapy, which is important to prevent rejection after organ transplantation, is influenced by satisfaction of patients with their medication regimen.

Objective: We investigated the effect of introducing a simplified medication regimen for renal transplant patients on treatment satisfaction, in particular, convenience.

Methods: In a prospective cohort study, treatment was switched from tacrolimus twice daily to tacrolimus once daily with a simultaneous change to a once-daily formulation of other drugs when applicable.

Early development of hyperparathyroidism due to loss of PTH transcriptional repression in patients with HNF1β mutations?

Context: Heterozygous mutations or deletions of the transcription factor hepatocyte nuclear factor 1β (HNF1β) result in a heterogeneous syndrome characterized by renal cysts and diabetes, together with a variety of other extrarenal and renal manifestations. Interestingly, in several patients with HNF1β abnormalities, we observed early hyperparathyroidism and PTH levels that we judged inappropriately high compared with the degree of renal function decline.

Objective: Based on the above clinical observations, we tested the hypothesis of a direct role of HNF1β in the transcriptional regulation of the human PTH gene in the parathyroid gland.

Effect of mild diarrhea on tacrolimus exposure.

Background: Diarrhea is a frequent adverse event in patients treated with the combination of tacrolimus and mycophenolate mofetil (MMF). In case of severe diarrhea, the total exposure to tacrolimus can substantially increase, which is reflected in a rise of the predose trough level (C0). In mild diarrhea (two to three stools per day), an increased exposure might occur without trough levels exceeding the target range, resulting in "silent" chronic tacrolimus overexposure.

Introduction of the CKD-EPI equation to estimate glomerular filtration rate in a Caucasian population.

Background: Chronic kidney disease (CKD) is defined as the presence of kidney damage, albuminuria or a reduction in glomerular filtration rate (GFR). A GFR <60 mL/min/1.73 m(2) alone is sufficient to diagnose CKD Stages III-V.