Abstract: FR-PO769
Curious Case of De Novo Lupus Nephritis in Geriatric Patient After Kidney Transplant
Session Information
- Post-Transplantation and Case Reports
November 03, 2023 | Location: Exhibit Hall, Pennsylvania Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Transplantation
- 2102 Transplantation: Clinical
Authors
- Elnigomy, Sheikan, The George Washington University Hospital, Washington, District of Columbia, United States
- Jagadeesan, Muralidharan, The George Washington University Hospital, Washington, District of Columbia, United States
- Shankaranarayanan, Divya, The George Washington University Hospital, Washington, District of Columbia, United States
Introduction
Glomerular nephritis after transplant can develop De novo or as a recurrence of primary GN. Glomerulonephritis (GN) after a kidney transplant significantly contributes to long-term graft loss. We present a rare de novo lupus nephritis (Membranous GN ) case after a kidney transplant.
Case Description
A 73 -year-old African American Male with a history of ESRD presumed secondary to long-standing HTN and DM. He had a Diseased Donor Kidney Transplant (DDKTx) 10 years ago, complicated by graft failure after five years of the transplant secondary to chronic allograft nephropathy diagnosed on kidney biopsy. He was restarted on hemodialysis and subsequently underwent a second DDKTx, Donor 38 AAF, KPDI 61%, CPRA 98%, CMV +/+, EBV +/+, Cold time 13 hours, induction therapy with Anti Thymoglobulin, bortezomib and Solumedrol and maintenance with Tacrolimus, Mycophenolate Mofetil, and prednisone. The post-transplant course is complicated by delayed Graft Function (DGF), 2nd-degree AV block type 1 Wenckebach, and paroxysmal atrial fibrillation. He has maintained the patient on dialysis for DGF. Laboratory studies revealed hemoglobin of 9.5 g/dL, platelets 200 x100 /µL, Leukopenia of 3.200, Creatinine 8 mg/dL, Urine with >500 protein, and 24 protein excretion is 4 grams. Urine Microscopy was bland. Work up for proteinuria; HIV, Hepatitis B, and C are negative , Low C3, and normal C4, Normal PT/INR and APTT. A kidney Biopsy was done in the second week of the transplant and showed Membranous GN, focal glomerulonephritis, and extraglomerular immune complex deposit, EXT2 positive favor autoimmune etiology. Then subsequently, Lupus work up positive for dsDNA.
The patient continued on the immunosuppression with Tacrolimus dose adjusted to achieve a level of 8-10, Mycophenolate Mofetil 360 twice a day ,and 40 mg of prednisone slowly tapered. In 4 weeks after discharge, the patient off dialysis Kidney functions improved Cr 1.7. Proteinuria resolved, and his three-month protocol kidney biopsy showed similar changes to the previous biopsy result.
Discussion
.De Novo GN after transplant are underdiagnosed because of chronic immune suppression state. Lupus nephritis can occur at any age and may reflect alloimmunization from a previous kidney transplant or an underlying autoimmune condition gets triggered during the transplant.