NEFROPATIJA UZROKOVANA BK VIRUSOM U BOLESNIKA S TRANSPLANTIRANIM SRCEM: PRVI DOKUMENTIRANI SLUČAJ U HRVATSKOJ

Autor: BRUNA BRUNETTA GAVRANIĆ, NIKOLINA BAŠIĆ-JUKIĆ, MARIJANA ĆORIĆ, BOŠKO SKORIĆ, DAVOR MILIČIĆ, PETAR KES
Jazyk: angličtina
Rok vydání: 2016
Předmět:
Zdroj: Acta medica Croatica : Časopis Akademije medicinskih znanosti Hrvatske
Volume 70
Issue Suplement 2
ISSN: 1848-8897
1330-0164
Popis: As outcomes following heart transplantation have improved significantly over the last years, chronic kidney disease has become an increasingly prevalent complication in this population. Polyomavirus-associated nephropathy (PVAN) of native kidneys has also been recognized increasingly as a cause of kidney failure. We report the first case of PVAN occurring in the native kidneys of a solid-organ transplant recipient in Croatia as the eighth case described in the literature worldwide. A 65-year-old female with dilatative cardiomyopathy and good kidney function had a heart transplanted in 2012. Initial immunosuppressive therapy consisted of antithymocyte immunoglobulin with cyclosporine, mycophenolate mofetil and corticosteroids. Soon after transplantation, her kidney function began to fail progressively. Biopsy of the native kidneys revealed PVAN, and everolimus was introduced in immunosuppressive therapy. Nevertheless, her renal dysfunction progressed and she is now being evaluated for cadaveric kidney transplantation. PVAN should be considered in the differential diagnosis of new-onset renal failure following non-kidney solid organ transplantation. Early diagnosis is essential for prevention of irreversible renal damage.
Unazad nekoliko godina sa značajnim poboljšanjem preživljenja bolesnika s transplantiranim srcem kronično zatajenje bubrega postalo je sve češća komplikacija u toj populaciji. Nefropatija uzrokovana poliomavirusom (PVAN) nativnih bubrega također se sve češće prepoznaje kao uzrok zatajenja bubrega. Prikazujemo prvi slučaj PVAN nativnih bubrega kod primatelja transplantata solidnog organa u Hrvatskoj i osmi takav slučaj dosad opisan u literaturi. Bolesnici u dobi od 65 godina s dilatativnom kardiomiopatijom i dobrom bubrežnom funkcijom je 2012. godine transplantirano srce. Inicijalna imunosupresivna terapija sastojala se od antitimocitnog imunoglobulina s ciklosporinom, mikofenolat mofetilom i kortikosteroidima. Ubrzo nakon transplantacije dolazi do zatajenja bubrega. Biopsijom nativnih bubrega postavljena je dijagnoza PVAN, a u imunosupresivnu terapiju je uveden everolimus. Usprkos tome dolazi do daljnjeg napredovanja zatajenja bubrega i bolesnica je trenutno u pripremi za kadaveričnu transplantaciju bubrega. PVAN treba razmotriti u diferencijalnoj dijagnozi novonastalog zatajenja bubrega nakon transplantacije solidnih organa. Rana dijagnoza PVAN je bitna u sprječavanju razvoja ireverzibilnog bubrežnog zatajenja.
Databáze: OpenAIRE
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