Associação entre a concentração sérica de tacrolimo e alterações no sumário de urina em pacientes pós transplante renal

Abstract

Kidney transplantation is the most common type of transplant performed in Brazil. Tacrolimus is one of the main drugs used in post-transplant immunosuppressive therapy and has nephrotoxicity as one of its main toxic effects, therefore requiring dosage adjustments. The urine summary is an invasive, simple and quick result collection test. Through it, some data related to urine is provided, where each one of them provides important clinical information regarding the patient's health. The present study aimed to evaluate the association between changes in urine output and blood levels of tacrolimus in post-kidney transplant patients. This is an observational, quali-quantitative and descriptive study carried out at the Hospital Universitário Walter Cantídio from April to December 2022. The results of the therapeutic monitoring tests for tacrolimus and the parameters of the urine summary were analyzed, as well as the sociodemographic data of kidney transplant recipients who underwent laboratory tests between the months of January 2021 and July 2022 in the period close to 1 year after the date of the transplant. The variables analyzed in the research were collected from medical records. The population (n=77) was mostly composed of men, of brown color, with a mean age of 51.5 years ± 12.5 years and from cities in the interior of the state of Ceará. Mean values of tacrolimus blood dosages were outside the reference values, whereas data from urine summaries showed few changes. As for the percentage of patients who presented alterations in the studied variables, 48.05% of these presented alterations in the blood levels of tacrolimus, adding up the percentages of patients above and below the stipulated therapeutic range. As for the percentage of patients with alterations in the results of the urine summary, in relation to the appearance, 7.79% (n=7) had slightly cloudy urine, only 3.9% (n=3) had glucose. As for leukocytes, 7.79% (n=6) had one cross, 2.6% (n=2) had two crosses, and 5.19% (n=4) had three crosses. With regard to casts, only 1.3% (n=1) obtained hyaline rares and granular rares. The data obtained by the research, despite the limitations related to the low sensitivity of the test, as well as the dependence on the analyst's expertise, alert researchers to the presence of leukocytes in the urine, even though there is still a need for further studies. for a better understanding of the effect of tacrolimus on renal function in this group of patients.