Long-distance running has gathered some momentum among health-conscious participants. However, some
studies have revealed association between long-distance running and development of acute kidney injury.
Although the impact usually lasts only for a few days after the event, some participants have been admitted for
severe acute kidney injury, the minority of which require dialysis treatment. The mechanisms underlying the
injury may include dehydration, development of rhabdomyolysis, heat stroke and concomitant use of NSAIDS.
Unfortunately, there is no long-term follow-up study to determine the long-term effect on kidney function.
Acute hyponatremia may develop in a significant proportion of long-distance runners. Majority of them were
asymptomatic but a few fatal cases which were supposedly due to cerebral oedema have been reported.
Excessive intake of hypotonic drinks, excessive sweating and secretion of non-osmotic antidiuretic hormone
have been postulated to be the causes of hyponatremia. This mini review will discuss the pathophysiology of
the development of acute kidney injury and hyponatremia. It will also discuss the prevention and treatment
of both conditions.
Aim: A once-daily formulation of tacrolimus, Advagraf®, is increasingly being used in place of twice-daily
tacrolimus, Prograf®, as a standard immunosuppressive agent for transplant patients. In this study, the
clinical safety and efficacy of Advagraf® were compared with Prograf®, among multi-ethnic Malaysian renal
transplanted population.
Method: This retrospective study identified renal transplant patients who were converted from Prograf® to
Advagraf® at the University Malaya Medical Centre (UMMC) (n=69). Clinical notes and laboratory records,
including tacrolimus daily dose and trough levels, were obtained for one-year, pre-and post-conversion. Causality
assessment of suspected adverse events were based on the WHO-Uppsala Monitoring Center criteria. Renal
biopsy records were re-evaluated based on the updated Banff 2007 classification for biopsy-confirmed acute
rejection (BPAR).
Results: Following conversion to Advagraf®, the mean tacrolimus trough level and daily dose decreased
significantly (p