Q: Almost 75 percent of post transplant patients, who get treated with with cyclosporine and tacrolimus develop some sort of hyperkalemia. What is the mechanism of action?


Answer: By aldosterone inhibition who receive immunosuppressive therapy with cyclosporine and tacrolimus develop some degree of hyperkalemia via two mechanism, patially due to diminished secretion of, and partially due to decreased responsiveness to, aldosterone.



References: 

1. Kamel KS, Ethier JH, Quaggin S, et al. Studies to determine the basis for hyperkalemia in recipients of a renal transplant who are treated with cyclosporine. J Am Soc Nephrol 1992; 2:1279. 

2. Heering PJ, Kurschat C, Vo DT, et al. Aldosterone resistance in kidney transplantation is in part induced by a down-regulation of mineralocorticoid receptor expression. Clin Transplant 2004; 18:186.