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Abstract: FR-PO752

Megalocytic Interstitial Nephritis in a Renal Transplant Patient

Session Information

Category: Transplantation

  • 2102 Transplantation: Clinical


  • Sannapaneni, Shilpa, Baylor Scott & White Health, Dallas, Texas, United States
  • Foster, Elissa, Baylor Scott & White Health, Dallas, Texas, United States
  • Akinfolarin, Akinwande A., Baylor Scott & White Health, Dallas, Texas, United States
  • Rice, Kim, Baylor Scott & White Health, Dallas, Texas, United States

Megalocytic interstitial nephritis is a rare form of interstitial nephritis first describe by Zollinger in 1945. The exact mechanism of the pathology is unknown but is presumed to be secondary to impairment of bacterial clearance by neutrophils and macrophages, especially in immune-deficient patients. It is clinically identical to the ineffective inflammatory process called malakoplakia. Here we present a unique case of megalocytic interstitial nephritis in a renal transplant patient.

Case Description

A 68-year-old male with medical history of end stage renal disease who underwent a transplant allograft biopsy, 15 months prior, presented with volume overload and acute kidney injury. He was diagnosed with cirrhosis after his transplant and clinical course was complicated by recurrent ascites requiring paracentesis, upper gastrointestinal bleeding requiring variceal banding. His exam was significant for bilateral leg swelling, tense abdomen. Labs on presentation were significant for creatinine of 4.26 mg/dL which was up from his baseline of 1 mg/dL. He underwent paracentesis on admission and the peritoneal fluid analysis was consistent with spontaneous bacterial peritonitis. He was started on antibiotics. His kidney function did not improve and biopsy was performed which showed megalocytic infiltration. He remained dialysis dependent despite antibiotics.


Our patient developed megalocytic interstitial nephritis in the setting of spontaneous bacterial peritonitis, likely as a consequence of seeding to the graft, in the setting of kidney transplant immunosuppression. It is a rare disorder and can only be diagnosed by histological examination. A high index of suspicion is required in immunosuppressed patients with slow renal recovery in setting of infection. Treatment of this disease includes antibiotics to control the infection and high dose steroids.