ASN's Mission

ASN leads the fight to prevent, treat, and cure kidney diseases throughout the world by educating health professionals and scientists, advancing research and innovation, communicating new knowledge, and advocating for the highest quality care for patients.

learn more

Contact ASN

1401 H St, NW, Ste 900, Washington, DC 20005

email@asn-online.org

202-640-4660

The Latest on Twitter

Kidney Week

Abstract: SA-PO1115

De Novo ANCA-Associated Glomerulonephritis in Post-Transplant Kidney

Session Information

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
CaseCase 1Case 2Case 3
Age593446
GenderFemale
Female
Female
RaceHispanic
Hispanic
Hispanic
Kidney disease etiology
Unknown
Unknown
Unknown
Allograft source
Living (brother)
Living (father)
Living (husband)
Time postransplantation, yr
23159
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
2.11.71,7
Proteinuria g/d
2.91.650.85
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