Fenofibrate-associated reversible acute allograft dysfunction in 3 renal transplant recipients: Biopsy evidence of tubular toxicity

Renal transplant recipients are susceptible to hyperlipidemia and the development of atherosclerosis as a consequence of the immunosuppressive agents they require, which include corticosteroids, calcineurin inhibitors, and sirolimus. Fibric acid derivatives and 3-hydroxymethylglutaryl-coenzyme A reductase inhibitors are prescribed commonly to optimize lipid profiles and reduce the risk of cardiovascular events in this type of setting. The authors describe 3 cases of reversible acute renal allograft dysfunction in patients treated with fenofibrate. Serum levels of monitored immunosuppressant agents remained therapeutic throughout the time period. Discontinuation of the fenofibrate resulted in the resolution of renal dysfunction. The pathologic changes to the proximal tubules in all 3 biopsy specimens were in keeping with a toxic rather than an ischemic etiology. Although the control of hyperlipidemia is crucial in the transplant patient population, the authors suggest that caution be exercised and serum creatinine levels be closely monitored in patients started on fibrates.