A case of rheumatoid arthritis/Sjogren's syndrome with acute renal failure due to hyperuricemia associated with mizoribine therapy

Tanaka, Hiroki; Abe, Takashi; Nishimura, Susumu; Sakai, Hajime; Kimura, Hirokazu; Oki, Masayuki; Nojima, Masanori; Taga, Masae; Matsumoto, S; Takahashi, Hiroki; Imai, Kohzoh

doi:10.2177/jsci.27.171

Cited by 8 publications

(3 citation statements)

References 4 publications

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“…Although the grade of hyperuricemia varies and is generally controllable, Tanaka et al reported a case of acute renal failure with marked hyperuricemia developing during mizoribine administration. 9 The reported case then underwent hemodialysis for 1 month. Other remarkable adverse effects have not been previously reported.…”

Section: Discussionmentioning

confidence: 99%

Stevens–Johnson syndrome induced by mizoribine in a patient with systemic lupus erythematosus

et al. 2006

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A 32-year-old Japanese woman, who had a treatment history of systemic lupus erythematosus (SLE) with lupus nephritis World Health Organization class IV for 11 months, visited our hospital due to fever, facial erythema, and erosion of the oral cavity on November 10, 2003. Her mucosal erosion and facial skin erythema progressed over the following week, and Stevens-Johnson syndrome was diagnosed due to pathological findings of the skin. Among the administrated drugs, only mizoribine, started 6 months earlier, produced a positive reaction in the drug lymphocyte stimulation test. Increased prednisolone and high dose intravenous gamma-globulin were given successfully. Cyclosporine at 50 mg was administered to control the SLE, followed by an increase to 100 mg on January 7, 2004. She suffered from abdominal pain, blindness, and convulsion on January 9. The magnetic resonance image of her brain prompted a diagnosis of reversible posterior leukoencephalopathy syndrome. After withdrawal of cyclosporine and control of hypertension, symptoms disappeared rapidly. Cyclophosphamide pulse therapy was successfully administrated to control lupus nephritis. This is the first report describing the relationship between Stevens-Johnson syndrome and mizoribine. Although the use of mizoribine is thought to be safe, careful observation is necessary.

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Section: Discussionmentioning

confidence: 99%

Stevens–Johnson syndrome induced by mizoribine in a patient with systemic lupus erythematosus

et al. 2006

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“…Hyperuricemia is a side effect of MZ treatment, and occasional cases of marked hyperuricemia leading to acute kidney injury (AKI) have been reported (2)(3)(4). Here, we report a case of hyperuricemia leading to AKI during MZ administration in a patient with Blau syndrome.…”

Section: Introductionmentioning

confidence: 90%

A Case of Acute Kidney Injury with Marked Hyperuricemia During Mizoribine Administration

et al. 2012

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A 52-year-old woman was diagnosed with Blau syndrome and rheumatoid arthritis and was treated with prednisolone and methotrexate. Joint pain and skin ulcers were poorly controlled; therefore, mizoribine (MZ; 150 mg/day) was administered once daily from March 2011. In early July 2011, the patient was hospitalized because of acute kidney injury (AKI) and acute pancreatitis. We reasoned that AKI resulted from hyperuricemia during MZ administration because serum concentrations of uric acid (31.6 mg/dL) and MZ (trough level, 5.14 μg/mL) were markedly elevated on admission. MZ should be administered with caution because of the risk of marked hyperuricemia leading to AKI.

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“…In addition to the efficacy and safety of MZR after renal transplantation, recent studies have demonstrated the utility in the treatment of childhood nephritic syndrome, SLE, and IgA nephropathy [8]. The major side effect of MZR derived from its original mechanism is hyperuricemia with an incidence of about 10% [9]. Other remarkable adverse effects have not been previously reported.…”

Section: Introductionmentioning

confidence: 99%

A case of lupus nephritis improved after appropriately adjusting the dosage of mizoribine

et al. 2007

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A 29-year-old male presenting nephrotic syndrome and facial skin erythema was admitted to our hospital in September of 2000. We diagnosed him as having systemic lupus erythematosus (SLE) accompanied by lupus nephritis (WHO class V). The disease activity had decreased after treatment with methylprednisolone (m-PSL) pulse therapy, which was followed by oral PSL. Thereafter, when tapering the dosage from 60 to 30 mg/day, the lupus nephritis flared up and he was re-hospitalized in February of 2001. After successful retreatment with m-PSL pulse therapy followed by the tapering of the dosage from 60 to 30 mg/day, we used mizoribine (MZR) as a combination therapy. The lupus nephritis flared up again after tapering down to 17.5 mg/day of PSL. Then, we changed the MZR dosage from 150 mg/day in three divided daily doses to 200 mg/day in two divided daily doses. This modification increased the peak blood concentration (Cmax) of MZR from 0.63 to 1.55 microg/ml. At present, we have been able to successfully taper the dosage to 7.5 mg/day of oral PSL and the patient has achieved a state of remission without any side effects. Monitoring of the serum concentration of MZR is thus considered to be important for achieving effective therapy of SLE, especially for steroid-resistant lupus nephritis. If the serum concentration of MZR does not reach an effective level, then the dosage of MZR should be adjusted appropriately in order to maintain an adequate serum concentration of MZR.

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A case of rheumatoid arthritis/Sjogren's syndrome with acute renal failure due to hyperuricemia associated with mizoribine therapy

Cited by 8 publications

References 4 publications

Stevens–Johnson syndrome induced by mizoribine in a patient with systemic lupus erythematosus

Stevens–Johnson syndrome induced by mizoribine in a patient with systemic lupus erythematosus

A Case of Acute Kidney Injury with Marked Hyperuricemia During Mizoribine Administration

A case of lupus nephritis improved after appropriately adjusting the dosage of mizoribine

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