Abstract: SA-PO1140
De Novo Minimal Change Disease Immediately After Renal Transplantation
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
- 1902 Transplantation: Clinical
Authors
- Tanemoto, Fumiaki, St. Luke's International Hospital, Tokyo, Japan
- Nagahama, Masahiko, St. Luke's International Hospital, Tokyo, Japan
- Nakayama, Masaaki, St. Luke's International Hospital, Tokyo, Japan
Introduction
De novo minimal change disease (MCD) is quite a rare cause of post-transplant nephrotic syndrome (NS). Only a few cases have been reported, partially due to the stringent criteria for this diagnosis. We report a challenging case of de novo MCD while the patient was on induction therapy immediately after transplantation.
Case Description
A 49-year-old male with end-stage kidney disease due to nephrosclerosis received ABO-compatible living kidney transplantation from his 47-year-old wife with four mismatches in HLA typing. Induction therapy included steroids, mycophenolate mofetil tacrolimus and basiliximab. At post-transplantation day 4, serum creatinine increased to 8.05 mg/dL with massive proteinuria (11.6 g/d). Although the flow cytometric crossmatch test for HLA came back negative, the patient received steroid pulse, plasma exchange and rituximab for possible recurrent focal segmental glomerulosclerosis (FSGS). Kidney function and proteinuria were improved soon after those treatments. The allograft biopsy taken on day 18 showed no specific glomerular changes under light microscopy; however, foot process effacement of podocytes was noted under the electron microscopy. De novo MCD was diagnosed. The patient has been achieved complete remission for one year since the transplant.
Discussion
De novo MCD after kidney transplantation is quite rare, but seems to have favorable prognosis. Nephrotic-range proteinuria usually develops immediately or shortly after transplantation, even when the patient is on induction therapy. Due to indistinguishable clinical course as well as similar histology of FSGS and MCD, it is possible that patients labeled as FSGS who respond readily to steroids or plasmapheresis may have MCD rather than FSGS. Therefore, the diagnosis of de novo MCD should be always considered even when induction therapy is given, especially if minimal light microscopic findings are detected.