Diagnosis and treatment of calcineurin inhibitor-induced pain syndrome in chronic Kidney disease Stage 5 transplantation

Abstract

Context: Musculoskeletal pain is a frequent manifestation in postrenal transplant recipients that caused by several diseases. Clinically used calcineurin inhibitors including cyclosporine A and tacrolimus can induce calcineurin inhibitor-induced bone pain syndrome which is characterized by severe pain, especially in both lower extremities. Aims: The aim of this study to investigate clinical studies about diagnostic and therapeutic modalities in renal transplant recipients. Settings and Design: In this retrospective study, patients with calcineurin inhibitor-induced pain syndrome after kidney transplantation were selected. Materials and Methods: This paper was searched via electronic PubMed and Google Scholar databases. Few full-text original articles in kidney transplant recipients were extracted. In this study, 18 articles were assessed for eligibility and 12 renal transplant recipients in 9 case reports were included. Statistical Analysis Used: Categorical variables as percentage, normally distributed measurements as mean ± standard deviation, and nonnormally distributed measurements as median and interquartile range were recorded. Results: Of 12 patients, 7 (58.3%) patients were male and 5 (41.6%) were female. At this study, bone magnetic resonance imaging (MRI) was diagnostic modality of choice. Radionuclide scintigraphy is also helpful. The most effective treatment of calcineurin inhibitor-induced pain syndrome consisted reduction dose of calcineurin inhibitors, calcineurin inhibitors change to another drug from the same drug class or mammalian target of rapamycin inhibitors. Conclusion: This study demonstrates that bone MRI is diagnostic modality of choice in patients with calcineurin inhibitor-induced pain syndrome. Moreover, reduction of calcineurin inhibitors and switching of immunosuppressants show the most effective treatment in these patients.

Keywords

• Calcineurin inhibitor-induced pain syndrome
• cyclosporine A
• gamma-aminobutyric acid analogs
• iloprost
• renal transplant
• tacrolimus