Tehran University Medical Journal

Normal 0 false false false EN-US X-NONE AR-SA MicrosoftInternetExplorer4 Background: Cyclosporine is one of the main immunosuppressors used for renal transplant recipients, and is given to prevent transplant rejection. Although the drug increases the survival of patients and grafted organs, it has some side effects independent of its effect on the immune system that are usually ignored. In this study, we evaluate the effect of cyclosporine on serum Mg levels and metabolic side effects in renal graft patients.
Methods: In this study, we followed 157 renal transplant recipients (62 females and 95 males) who were being treated with cyclosporine at a private clinic to prevent transplant rejection. The patients were first physically examined and then blood samples were obtained in order to measure levels of cyclosporine, Mg, creatinine, fasting blood sugar, lipids, calcium, phosphorus, and uric acid levels. We then analyzed the data for correlations between serum Mg levels, cyclosporine and other metabolic complications.
Results: The mean levels of Mg and cyclosporine were 196±0.31mg/dl and 371±192 μg/dl, respectively. Hypomagnesemia was detected in 16 patients (10.2%).There was a significant negative correlation (p<0.05) between levels of Mg and cyclosporine levels (r=-0.53), serum creatinine (r=-0.61), plasma LDL (r=-0.3), fasting blood sugar (r=-0.60) and uric acid (r=-0.36), and no correlation (p>0.05) between levels of Mg and calcium (r=0.2), phosphorus (r=-0.01), triglycerides (r=0.06) and HDL (r=-0.08). Mean levels of cyclosporine, creatinine, LDL, fasting blood sugar and uric acid in patients with hypomagnesemia were significantly different from those patients with normal serum Mg levels (p<0.05). There was no significant difference between the two groups with regard to mean total cholesterol, HDL, calcium and phosphorus (p>0.05).
Conclusion: According to the results of this and previous studies, there is a significant correlation between cyclosporine levels and hypomagnesemia as well as other biomedical complications secondary to hypomagnesemia. Therefore, we recommend routine serum Mg determination and greater attention to hypomagnesemic patients to prevent further complications.

Background: Reflex Sympathetic Dystrophy Syndrome (RSDS) is a rarely described complication which characterized by pain, edema, movement and vasomotor disorders, trophic changes in the skin and patchy demineralization of bone in extremities. There are numerous risk factors such as trauma, surgery, myocardial infraction and drugs. Cyclosporine (CsA) is one of the drugs which can induce RSDS.

Case report: Herein we described a 33- years old man (known case of ALL) with severe painful and edematous extremities, which was being treated with cyclosporine because of Graft Versus Host Disease (GVHD) after bone marrow transplantation. His laboratory tests were normal except for AST and ALT. With impression of Reflex Sympathetic Dystrophy Syndrome triple-phase bone scan was done, Increased uptake and delayed wash-out in vascular and bony phase is considered typical for RSDS. Due to clinical and triple-phase bone scan findings the diagnosis was established. Symptoms of RSDS improved when CsA was discontinued.

Conclusion: According to this case report and the other ones, Cyclosporine should be considered as the etiology of Reflex Sympathetic Dystrophy Syndrome.