Immune Complex Mediated Glomerulonephritis with Acute Thrombotic Microangiopathy following Newly Detected Hepatitis B Virus Infection in a Kidney Transplant Recipient
Autor: | William Newsholme, Rachel Hilton, Catherine Horsfield, Tracey Salter, Sam Douthwaite, Hannah Burton |
---|---|
Rok vydání: | 2016 |
Předmět: |
Thrombotic microangiopathy
medicine.medical_treatment lcsh:Surgery 030232 urology & nephrology Case Report medicine.disease_cause 03 medical and health sciences 0302 clinical medicine Management of Technology and Innovation medicine 030212 general & internal medicine Renal replacement therapy Hepatitis B virus business.industry Acute kidney injury virus diseases Glomerulonephritis Immunosuppression lcsh:RD1-811 Entecavir medicine.disease digestive system diseases Immunology business Viral load medicine.drug |
Zdroj: | Case Reports in Transplantation, Vol 2016 (2016) Case Reports in Transplantation |
ISSN: | 2090-6951 2090-6943 |
Popis: | Hepatitis B virus (HBV) presents a risk to patients and staff in renal units. To minimise viral transmission, there are international and UK guidelines recommending HBV immunisation for patients commencing renal replacement therapy (RRT) and HBV surveillance in kidney transplant recipients. We report the case of a 56-year-old male who was immunised against HBV before starting haemodialysis. He received a deceased donor kidney transplant three years later, at which time there was no evidence of HBV infection. After a further six years he developed an acute kidney injury; allograft biopsy revealed an acute thrombotic microangiopathy (TMA) with glomerulitis, peritubular capillaritis, and C4d staining. Due to a “full house” immunoprofile, tests including virological screening were undertaken, which revealed acute HBV infection. Entecavir treatment resulted in an improvement in viral load and kidney function. HBV genotyping demonstrated a vaccine escape mutant, suggesting “past resolved” infection that reactivated with immunosuppression, though posttransplant acquisition cannot be excluded. This is the first reported case of acute HBV infection associated with immune complex mediated glomerulonephritis and TMA. Furthermore, it highlights the importance of HBV surveillance in kidney transplant recipients, which although addressed by UK guidelines is not currently practiced in all UK units. |
Databáze: | OpenAIRE |
Externí odkaz: |