Discussion
In this case report, we shared the pretransplantation and posttransplantation process of McArdle patient who had kidney transplantation from a living donor (husband). To the best of our knowledge, this case was a first in the literature.Mcardle is a rare disease that is generally lately diagnosed. The long-term and intensive exercise cause rhabdomyolysis in this patient. The most common laboratory results are myoglobinuria and elevated CK levels. The recurrent myoglobinuria attacks are seen in more than %50 of patients. Myoglobin is excreted by the kidney and can cause kidney injury. Myoglobinuria has a toxic effect on renal tubular cells and causes damage through the tubular obstruction. Acute kidney disease is extremely rare in McArdle patients.
In the Spanish national registry, acute kidney injury has been reported at a rate of 4 percent. In a study in the United Kingdom, myoglobinuria and acute kidney injury are reported at the rate of 62% and 11% percent respectively. In our patient, there was history of hypertension which started with elevated creatinin levels. He had no high blood pressure levels which can cause end stage renal disease. In addition, there were no history of habits such as cigarette, and alchohol or comorbid diseases, which could explain the end stage renal disease. The history of more than 50 rabdomylosis attacks and absense of any other possible etiology, which can explain the pathology, suggested the rabdomylosis attacks as a most possible cause of end stage renal disease.
The rabdomyolysis following the kidney transplantation, delayed graft rejection, and even graft loss were among the possible post-transplantation risks. Rhabdomyolysis has been reported in kidney transplantation cases due to the immunosuppressions used (tacrolimus and CD 25 monoclonal antibody). (10-11) We did not observe rabdomylosis in the post operative period in our case in which tacrolimus and anti-thymocyte were used as induction or immunsuppressant agents. Kidney transplantation can be performed in McArdle patients with end-stage renal disease in the appropriate preoperative and postoperative conditions.