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Abstract: FR-PO764

An Unusual Cause of Reversible Nephrotic Syndrome in a Kidney Transplant Recipient

Session Information

Category: Transplantation

  • 2102 Transplantation: Clinical


  • Brooker, David Michael, Allegheny Health Network, Pittsburgh, Pennsylvania, United States
  • Soundranayagam, Sheahahn V., Allegheny Health Network, Pittsburgh, Pennsylvania, United States
  • Sureshkumar, Kalathil K., Allegheny Health Network, Pittsburgh, Pennsylvania, United States
  • Daloul, Reem, Allegheny Health Network, Pittsburgh, Pennsylvania, United States

New onset proteinuria in kidney transplant recipients (KTRs) could be related to recurrent/de novo glomerular diseases or more commonly to chronic antibody mediated rejection. We present a KTR who had a very uncommon cause of nephrotic syndrome.

Case Description

A 73-year old female with diabetic nephropathy underwent deceased donor kidney transplantation using Thymoglobulin induction and tacrolimus/ mycophenolate mofetil maintenance along with infection prophylaxis using valgancyclovir and trimethoprim-sulfamethoxzole. There was prompt allograft function with a nadir serum creatinine of 1.3 mg/dl. Serum creatinine started increasing 4 months post-transplant and patient developed significant edema along with worsening hypertension. Further evaluation revealed new nephrotic range proteinuria, hypoalbuminemia, no DSA, along with negative infectious and monoclonal gammopathy work up. Kidney allograft biopsy showed no rejection, negative immunofluorescence, with segmental foot process effacement without transplant glomerulopathy or immune deposits on electron microscopy. Repeat allograft biopsy 2 weeks later showed similar findings. Allograft Doppler ultrasound revealed increased peak systolic velocity of 240 cm/sec in the renal artery which increased to 289 cm/sec on repeat Doppler study 2 weeks later. Based on the Doppler finding, persistent allograft dysfunction and hypertension, patient underwent CO2 angiogram that revealed severe stenosis of the transplant renal artery near the anastomosis with external iliac artery. Stenosis was successfully treated with balloon angioplasty. Within next several weeks, there was improvement in serum creatinine to 1.29 mg/dl and proteinuria to 0.5 g/d.


Nephrotic range proteinuria is an uncommon presentation of renal artery stenosis (RAS) that has previously been reported in native kidneys. Our case shows that similar presentation can occur in allograft kidneys. Transplant RAS should be considered as a potential cause for nephrotic syndrome in KTRs.