An early case of de novo membranous nephropathy in a renal transplant patient
| Autor: | F Teixeira e Costa, J.R. Pinto, Filomena A. Carvalho, MJ Galvão |
|---|---|
| Rok vydání: | 2002 |
| Předmět: |
Graft Rejection
medicine.medical_specialty Adolescent Biopsy Antiviral Agents Methylprednisolone Gastroenterology White People chemistry.chemical_compound Postoperative Complications Membranous nephropathy Internal medicine Cadaver medicine Humans Transplantation Homologous Kidney transplantation Transplantation Creatinine Proteinuria medicine.diagnostic_test business.industry Histocompatibility Testing medicine.disease Kidney Transplantation Tissue Donors Uremia Surgery Treatment Outcome chemistry Immunoglobulin G Cytomegalovirus Infections Female Kidney Diseases medicine.symptom business Kidney disease |
| Zdroj: | Transplantation Proceedings. 34:364 |
| ISSN: | 0041-1345 |
| DOI: | 10.1016/s0041-1345(01)02803-2 |
| Popis: | Emergency haemodialysis was started on an 18-year-oldfemale Caucasian (HLA A 22, 28; B 8, 18; DR 3, 5) whopresented with severe uremia. There was no past history ofdisease, namely she denied edema, frothy urine, hyperten-sion, or other urinary symptoms. Biopsy was not performeddue to small regular kidneys.Aged 21, she received a cadaveric renal allograft from aCMV IgG-positive donor. The CMV status of the patientwas unavailable at this stage. The back-table donor biopsyshowed a normal kidney with mild interstitial edema andoccasional atrophic tubules. Immunosuppression wasstarted consisting of cyclosporine A, azathioprine, andprednisone. There was immediate function, with serumcreatinine of 1.8 mg/dL on the second day, which droppedto 1.3 mg/dL at discharge on day 15.One month posttransplant, a rise in serum creatinine to3.9 mg/dl led to a graft biopsy being performed, whichshowed a mild acute cellular rejection. Treatment withmethylprednisolone 500 mg 3 was attended by return toprevious creatinine value of 1.4 mg/dL. At this time, CMVimmediate early antigen (IEA) became positive. She wastreated with anti-CMV hyperimmune globulin and gancy-clovir. Despite this, CMV antigenemia (positive IEA) waspresent until month 5. At this time, a positive dipstick forprotein led to a 24-hour collection being performed, whichshowed 3.6 g of proteinuria to be present. Although serumcreatinine remained stable at 1.0 mg/dL, a second biopsywas performed and showed MN of the graft. Immunoper-oxidase staining with monoclonal serum for CMV wasnegative. After review of the 1 month, biopsy with adequatestaining, it was thought that thickening of the basal mem-branes was already present, alongside acute rejection.At month 8 serum creatinine was 0.8 mg/dL, proteinuriawas absent, and the patient edema free. The most frequentcauses of secondary MN have been excluded (drug-induced,tumor-associated, autoimmune, infection-related).Four weeks after the first positive IEA result, the patientwas CMV IgM negative and IgG positive. Ten weeks latershe became IgM positive and IgG positive. These findingswere present after 12 more weeks. |
| Databáze: | OpenAIRE |
| Externí odkaz: |
|
Full Text from ScienceDirect