Proximal Tubular Injury in Medullary Rays Is an Early Sign of Acute Tacrolimus Nephrotoxicity

Table 1

Flowchart of serum tacrolimus levels and clinical hepatic and renal indices in index case.

	12 days before	1 day before	Liver transplant	Days after transplant
				9	12	34	35 (biopsy day)	41	45	1 year
FK	—	—	3.1	6.4	5.1	9.9	28.0	8.7	6.5	8.8
Cr	0.8	0.7	0.8	0.9	1.6	3.0	2.8	2.4	1.4	1.0
BUN	10	11	32	18	38	59	59	53	22	22
AP	173	188	74	98	—	—	81	223	100	104
AST	79	89	144	16	—	—	21	29	25	32
ALT	58	61	246	61	—	—	9	15	19	46
Total bili.	4.0	3.2	1.4	0.9	—	—	0.3	0.4	0.4	0.5

FK: FK506 (ng/dL); Cr: creatinine (mg/dL); BUN: blood urea nitrogen (mg/dL); AP: alkaline phosphatase (25–125 U/L); AST: aspartate aminotransferase (8–36 U/L); ALT: alanine aminotransferase (8–67 U/L); total bili.: total bilirubin (0.3–1.3 mg/dL). —: not available.