A rare case of vascular rejection in a renal transplant recipient with nephrotic range proteinuria

Abstract:  In the post‐cyclosporine A era, it has been reported that acute rejection after kidney transplantation is commonly revealed as an asymptomatic increase in the serum creatinine level. Nephrotic range proteinuria is observed in patients with recurrent or de novo glomerulonephritis, or with chronic transplant nephropathy and glomerulopathy in the late phase. Acute rejection occurring with nephrotic range proteinuria without a rise of serum creatinine has been rarely reported. Here, we report a rare case of vascular rejection in a renal transplant recipient with nephrotic range proteinuria. A 34‐yr‐old male renal transplant recipient presented with acute vascular rejection and early‐onset nephrotic syndrome. Severe nephrotic range proteinuria was detected with a minimally elevated level of serum creatinine. Biopsy showed severe glomerulitis and vasculitis, which was relieved by conversion of the immunosupressant regimen. Severe proteinuria was a sign of acute vascular rejection with severe glomerulitis and vasculitis. Careful observation to ensure maintenance of immunosuppression is necessary in such cases.

[1]  Francis L. Delmonico,et al.  ACUTE HUMORAL REJECTION IN RENAL ALLOGRAFT RECIPIENTS: I. INCIDENCE, SEROLOGY AND CLINICAL CHARACTERISTICS1 , 2001, Transplantation.

[2]  S. Bonsib,et al.  Acute rejection presenting as nephrotic syndrome. , 2000, Transplantation.

[3]  R. Colvin,et al.  Complement activation in acute humoral renal allograft rejection: diagnostic significance of C4d deposits in peritubular capillaries. , 1999, Journal of the American Society of Nephrology : JASN.

[4]  H. E. Hansen,et al.  The Banff 97 working classification of renal allograft pathology. , 1999, Kidney international.

[5]  R. Colvin,et al.  Plasma exchange and tacrolimus-mycophenolate rescue for acute humoral rejection in kidney transplantation. , 1998, Transplantation.

[6]  T. Cavallo,et al.  Proteinuria following renal transplantation: correlation with histopathology and outcome. , 1997, Transplantation proceedings.

[7]  P. Halloran,et al.  Pathologic features of acute renal allograft rejection associated with donor-specific antibody, Analysis using the Banff grading schema. , 1996, Transplantation.

[8]  M. Pescovitz,et al.  Reduced human IgG anti-ATGAM antibody formation in renal transplant recipients receiving mycophenolate mofetil. , 1995, Transplantation.

[9]  H. Kim,et al.  Proteinuria in renal transplant recipients: incidence, cause, and prognostic importance. , 1994, Transplantation proceedings.

[10]  P. Halloran,et al.  THE SIGNIFICANCE OF THE ANTI–CLASS I RESPONSE , 1992, Transplantation.

[11]  P. Halloran,et al.  The significance of the anti-class I antibody response. I. Clinical and pathologic features of anti-class I-mediated rejection. , 1990, Transplantation.

[12]  E. Cole,et al.  Proteinuria in renal transplant recipients: incidence, cause, prognostic importance. , 1988, Transplantation proceedings.

[13]  W. Waltzer,et al.  Allograft rejection and the nephrotic syndrome. , 1985, Transplantation Proceedings.

[14]  J. Alexander,et al.  PROTEINURIA FOLLOWING TRANSPLANTATION: Correlation With Histopathology And Outcome , 1984, Transplantation.

[15]  A. Besarab,et al.  Diagnostic and prognostic significance of an increase in fractional protein clearance ratio before and during rejection of renal transplant. , 1981, Transplantation.

[16]  M. Susin,et al.  Kidney transplant nephrotic syndrome: relationship between allograft histopathology and natural course. , 1980, Kidney international.

[17]  D. Hume,et al.  Proteinuria and nephrotic syndrome associated with chronic rejection of kidney transplants. , 1968, The New England journal of medicine.

[18]  D. Hume,et al.  Proteinuria and Nephrotic Syndrome Associated with Chronic Rejection of Kidney Transplants , 1967 .