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De novo lupus nephritis in a renal transplanted child: a case report.

Abstract

De novo lupus nephritis (LN) is a rare complication in renal transplantation recipients. We present the clinical manifestations of de novo LN in a 12-year-old boy who received a cadaveric renal transplant. The cause of end-stage renal disease was prune belly syndrome with renal dysplasia. His immunosuppressive drugs included tacrolimus, mycophenolate sodium, and prednisolone. After 3 years of treatment, he developed nephrotic syndrome (NS) without other symptoms of systemic lupus erythematosus (SLE). The renal pathology of the transplanted kidney showed suspicious acute cellular rejection and LN World Health Organization class IV-G (A/C). Antinuclear antibody was positive, but anti-dsDNA and anti-Smith were negative. The serum complements were initially normal. Pulse methylprednisolone was given and the dosages of all immunosuppressive drugs increased; notwithstanding, his edema and hypoalbuminemia worsened. Repeated biopsy of the transplanted kidney was done. A full-house pattern was documented under immunofluorescent examination which confirmed LN WHO class IV-G (A/C) without evidence of rejection. He then developed macrophage-associated hemophagocytic syndrome and cytomegalovirus pneumonia. He ultimately developed pulmonary hemorrhage and died owing to severe pneumonia. De novo LN should be considered in renal transplant recipients with new onset of NS despite there not being any other clinical manifestations of SLE.

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  • Authors+Show Affiliations

    ,

    Department of Pediatrics, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand. Electronic address: drsuwannee@yahoo.com.

    ,

    Department of Pediatrics, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand.

    Department of Pathology, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand.

    Source

    Transplantation proceedings 46:2 2014 pg 648-50

    MeSH

    Antibodies, Antinuclear
    Child
    Fatal Outcome
    Humans
    Immunosuppressive Agents
    Kidney Transplantation
    Lupus Nephritis
    Male

    Pub Type(s)

    Case Reports
    Journal Article

    Language

    eng

    PubMed ID

    24656036

    Citation

    Wisanuyotin, S, et al. "De Novo Lupus Nephritis in a Renal Transplanted Child: a Case Report." Transplantation Proceedings, vol. 46, no. 2, 2014, pp. 648-50.
    Wisanuyotin S, Jiravuttipong A, Puapairoj A. De novo lupus nephritis in a renal transplanted child: a case report. Transplant Proc. 2014;46(2):648-50.
    Wisanuyotin, S., Jiravuttipong, A., & Puapairoj, A. (2014). De novo lupus nephritis in a renal transplanted child: a case report. Transplantation Proceedings, 46(2), pp. 648-50. doi:10.1016/j.transproceed.2013.12.023.
    Wisanuyotin S, Jiravuttipong A, Puapairoj A. De Novo Lupus Nephritis in a Renal Transplanted Child: a Case Report. Transplant Proc. 2014;46(2):648-50. PubMed PMID: 24656036.
    * Article titles in AMA citation format should be in sentence-case
    TY - JOUR T1 - De novo lupus nephritis in a renal transplanted child: a case report. AU - Wisanuyotin,S, AU - Jiravuttipong,A, AU - Puapairoj,A, PY - 2013/09/27/received PY - 2013/12/10/accepted PY - 2014/3/25/entrez PY - 2014/3/25/pubmed PY - 2014/12/15/medline SP - 648 EP - 50 JF - Transplantation proceedings JO - Transplant. Proc. VL - 46 IS - 2 N2 - De novo lupus nephritis (LN) is a rare complication in renal transplantation recipients. We present the clinical manifestations of de novo LN in a 12-year-old boy who received a cadaveric renal transplant. The cause of end-stage renal disease was prune belly syndrome with renal dysplasia. His immunosuppressive drugs included tacrolimus, mycophenolate sodium, and prednisolone. After 3 years of treatment, he developed nephrotic syndrome (NS) without other symptoms of systemic lupus erythematosus (SLE). The renal pathology of the transplanted kidney showed suspicious acute cellular rejection and LN World Health Organization class IV-G (A/C). Antinuclear antibody was positive, but anti-dsDNA and anti-Smith were negative. The serum complements were initially normal. Pulse methylprednisolone was given and the dosages of all immunosuppressive drugs increased; notwithstanding, his edema and hypoalbuminemia worsened. Repeated biopsy of the transplanted kidney was done. A full-house pattern was documented under immunofluorescent examination which confirmed LN WHO class IV-G (A/C) without evidence of rejection. He then developed macrophage-associated hemophagocytic syndrome and cytomegalovirus pneumonia. He ultimately developed pulmonary hemorrhage and died owing to severe pneumonia. De novo LN should be considered in renal transplant recipients with new onset of NS despite there not being any other clinical manifestations of SLE. SN - 1873-2623 UR - https://www.unboundmedicine.com/medline/citation/24656036/De_novo_lupus_nephritis_in_a_renal_transplanted_child:_a_case_report_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0041-1345(13)01419-X DB - PRIME DP - Unbound Medicine ER -