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논문분류	춘계학술대회 초록집
제목	Prolonged hypokalemia and metabolic alkalosis by hypomagnesemia in a patient with kidney transplantation
저자	Eujin Lee
출판정보	2023; 2023(1):
키워드
초록	Hypomagnesemia is frequently reported after kidney transplantation, and it is known to be associated with the use of calcineurin inhibitors (CNIs) which can induce renal waste of magnesium. Hypomagnesemia usually develops within the first few weeks following transplantation reaching nadir around the second month post-transplantation. Here, we report a case of late-onset hypomagnesemia combined with hypokalemic alkalosis. A 40-year-old man with end-stage renal disease of unknown cause underwent kidney transplantation from a 21-year-old deceased donor. The patient received hemodialysis for seven years before transplantation and had no evidence of hereditary tubular or hormonal dysfunctions. Standard triple immunosuppressive therapy, consist of corticosteroid, tacrolimus and mycophenolate mofetil (MMF), was initiated after successful kidney transplantation The patient’s kidney functioned was preserved until recently, maintaining serum creatinine below 1.0mg/dL and eGFR (CKD-EPI) around 100 to 120mL/min/1.73m2. At twenty-three months post-transplantation (age 42), the patient was diagnosed new-onset diabetes after transplantation (NODAT). And thirty months later, his laboratory tests started to report hypokalemia ranging from 2.64~3.03mEq/L without any symptoms (Table 1). Initially, potassium chloride (600mg twice a day) was prescribed for oral supplements, but it was less responsive. At this point, his medications included immunosuppressives (low-dose corticosteroid, tacrolimus, MMF), antihypertensives (nifedipine, candesartan, carvedilol), and anti-diabetic agents (metformin, dapagliflozin, insulin). Because his graft function was stable under current combination of immunosuppressants, tacrolimus was not replaced with other agents. Recent measurement of magnesium and total CO2revealed hypomagnesemia (1.39mg/dL) and alkalosis (29.7mEq/L) His trans-tubular potassium gradient (TTKG) ranged from 5.1 to 7.3. Magnesium oxide (250mg twice a day) was added to correct hypomagnesemia and as serum magnesium levels began to rise, serum potassium level is slowly increasing and total CO2 is decreasing.
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