Abstract: SA-PO1115
De Novo ANCA-Associated Glomerulonephritis in Post-Transplant Kidney
Session Information
- Transplant Trainee Case Reports
November 09, 2019 | Location: Exhibit Hall, Walter E. Washington Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Trainee Case Report
- 1202 Glomerular Diseases: Immunology and Inflammation
Authors
- Vasquez jiménez, Enzo Christopher, Instituto Nacional de Cardiologia, Ciudad de México, Mexico
- Madero, Magdalena, Instituto Nacional de Cardiologia, Ciudad de México, Mexico
- Soto, Virgilia, INC Ignacio Chavez, Mexico City, Mexico
- Vazquez, Sergio, National Institute of Cardiology, Mexico City, Mexico
Introduction
De novo pauciimmune (ANCA-positive) GN in renal transplant is rare. Clinically, there is a rapid rise in serum creatinine level, accompanied by an active urine sediment, with or without symptoms of vasculitis involving others organs.
The ANCA associated vasculitides can lead to segmental necrotizing or global necrotizing inflammation of the glomeruli, with the formation of crescents, an absence or paucity of glomerular immunoglobulins or complement, and ussualy rapidly progressive glomerulonephritis
Case Description
We report three cases of patients with living donor kidney transplant who had chronic kidney disease of undetermined cause, with a long time since the transplant. They developed graft dysfunction and proteinuria, so a renal biopsy was performed. Table 1,
Discussion
Urinary abnormalities such as microhematuria and proteinuria are good indicators for the diagnosis of relapsing and de novo glomerulonephritis in kidney allograft in both cases. Combined with the urinary abnormalities, a confirmation of characteristic histological lesions to ANCA-V; necrotizing crescentic glomerulonephritis and/or small vessel vasculitis, by renal biopsy was required for the diagnosis of ANCA-V.
The outcome of renal function is usually bad, with loss of renal function and fibrosis; In the case of the first patient, a second renal biopsy was performed with interstitial fibrosis III, and in the case of patient 2, she is currently under treatment.
Characteristics of patients
| Case | Case 1 | Case 2 | Case 3 |
| Age | 59 | 34 | 46 |
| Gender | Female | Female | Female |
| Race | Hispanic | Hispanic | Hispanic |
| Kidney disease etiology | Unknown | Unknown | Unknown |
| Allograft source | Living (brother) | Living (father) | Living (husband) |
| Time postransplantation, yr | 23 | 15 | 9 |
| Previous Treatment | Prednisone 5 mg/d Mofetil micofenolate 500 mg bid | Prednisone 5 mg/d Mofetil micofenolate 500 mg bid Cyclosporine 75 mg bid. | Prednisone 5 mg/d Mofetil micofenolate 500 mg bid Cyclosporine 125 mg bid. |
| sCr at biopsy, mg/dl | 2.1 | 1.7 | 1,7 |
| Proteinuria g/d | 2.9 | 1.65 | 0.85 |
| Treatment | Methylprednisolone 3 g. RTX 375 mg/m2 | Methylprednisolone 3 g. RTX 375 mg/m2 | Methylprednisolone 3 g. CFM 6 g |
| 6 Mo Follow up | sCr 1.4, GFR 41 ml/min P/C 2g/g. | In treatment. | sCr 1.4, GFR 41 ml/min P/C 0.2 |