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.