| Autor: |
Yu Kijima, Tomokazu Shimizu, Shinya Kato, Kana Kano, Toshihide Horiuchi, Taiji Nozaki, Kazuya Omoto, Masashi Inui, Hiroshi Toma, Shoichi Iida, Toshio Takagi |
| Jazyk: |
angličtina |
| Rok vydání: |
2023 |
| Předmět: |
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| Zdroj: |
Transplantation Reports, Vol 8, Iss 3, Pp 100138- (2023) |
| Druh dokumentu: |
article |
| ISSN: |
2451-9596 |
| DOI: |
10.1016/j.tpr.2023.100138 |
| Popis: |
We present a rare case of a patient with complete C4 deficiency who underwent kidney transplantation and experienced immunoglobulin M-monoclonalgammopathyofrenalsignificance (IgM-MGRS) recurrence after the procedure. A 45-year-old male patient presented with end-stage renal failure due to membranoproliferative glomerulonephritis (MPGN). The initial immunosuppressive regimen consisted of tacrolimus, steroids, mycophenolate mofetil, basiliximab, and rituximab. He underwent ABO-incompatible kidney transplantation from his mother in August 2021. The clinical course after kidney transplantation was uneventful for a month. A biopsy of the transplanted kidney was performed due to decreased renal function. The allograft biopsy result led to the suspicion of primary macroglobulinemia-associated nephropathy. Bone marrow biopsy revealed an increase in plasma cells; however, no diagnosis of primary macroglobulinemia was made. At this point, IgM-MGRS was diagnosed instead of primary macroglobulinemia. A follow-up allograft biopsy was performed, and IgM-MGRS-associated nephropathy was diagnosed. Eventually, his retrieved autologous kidney biopsy from the initial examination showed that the primary disease was not MPGN but recurrent IgM-MGRS-associated nephropathy. Dexamethasone, rituximab, and cyclophosphamide (DRC) were started to treat IgM-MGRS due to worsening renal function (serum creatinine levels were in the 4–5 mg/dL range). Additional doses of DRC with 20 cycles of plasma exchange were introduced. Severe side effects occurred but did not result in death. |
| Databáze: |
Directory of Open Access Journals |
| Externí odkaz: |
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