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Year : 2018  |  Volume : 12  |  Issue : 2  |  Page : 149-151

Trimethoprim-induced hyperkalemia in renal transplant recipient

Department of Nephrology, MGM Medical College, Aurangabad, Maharashtra, India

Correspondence Address:
Dr. Sudhir G Kulkarni
5th Floor, Department of Nephrology, MGM Medical College, Aurangabad, Maharashtra
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/ijot.ijot_4_18

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Trimethoprim-sulfamethoxazole (TMP-SMX) is an antimicrobial agent used in a variety of infections. Adverse reactions are more common in patients with AIDS but occasionally occur in immunocompetent patients. Renal toxicity is usually a hypersensitivity reaction to the sulfa component and manifests as interstitial nephritis or sulfa crystallization in the renal tubules. Reversible hyperkalemia is a rarely reported side effect of TMP-SMX therapy attributed to TMP inhibition of potassium secretion in the distal renal tubule in a manner similar to the potassium-sparing diuretic, amiloride. We report a case of hyperkalemia associated with TMP-SMX occurring in a 32-year-old renal transplant recipient with no other risk factors for hyperkalemia. He was treated with TMP-SMX (800 mg + 160 mg) two tablets QID for suspected pneumocystis jiroveci pneumonia. He developed severe hyperkalemia on day 9 posttherapy. Hyperkalemia reverted to normal with withdrawal of trimethoprim.

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