Severe symptomatic hyponatremia--an uncommon presentation of tacrolimus nephrotoxicity.

Though tacrolimus-induced nephrotoxicity and hyperkalemia are well known, severe symptomatic hyponatremia is not commonly documented with its use. Here, we report a case of severe symptomatic hyponatremia in a renal transplant recipient on tacrolimus despite normal tacrolimus trough level. All other potential causes of hyponatremia were ruled out in this patient.

Lupus activation with cerebritis following pegylated interferon in a hemodialysis patient.

Background: A 20-year-old female patient with chronic hepatitis C virus infection and end-stage renal disease due to systemic lupus erythematosus was admitted to hospital with fever, pain in the abdomen, seizures and an alteration of consciousness. The patient was on maintenance dialysis and was receiving pegylated interferon monotherapy for her chronic hepatitis C virus infection.

Investigations: Physical examination, laboratory tests including complete blood count and measurement of serum electrolyte levels, CT scans of the head and abdomen, MRI of the brain, microscopic examination of the cerebrospinal fluid, chest X-ray, echocardiography and measurement of C3 complement and anti-double-stranded DNA antibody levels.