Acute rejection presenting as nephrotic syndrome.

BACKGROUND Early diagnosis and treatment of acute rejection is important to prevent continued renal injury. Acute rejection most commonly presents with asymptomatic rise in serum creatinine. Proteinuria associated with acute rejection is well established; however, there is limited documentation of the presentation of acute rejection as nephrotic syndrome in the literature. METHODS AND RESULTS We report a renal transplant patient who presented with early onset nephrotic syndrome without change in serum creatinine, whose allograft biopsy confirmed acute glomerulitis and vascular rejection. Treatment of the acute rejection was accompanied by resolution of the nephrotic syndrome. A second episode of acute rejection was also manifested as nephrotic range proteinuria. CONCLUSION The nephrotic syndrome in early post-transplantation period should prompt a work-up for acute rejection even in the absence of the common findings of this complication.

[1]  R. Colvin,et al.  De novo collapsing glomerulopathy in renal allografts. , 1998, Transplantation.

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

[3]  F. Gudat,et al.  Renal transplant morphology after long-term therapy with cyclosporine. , 1995, Transplantation proceedings.

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

[5]  J. Soulillou,et al.  RECURRENT NEPHROTIC SYNDROME FOLLOWING RENAL TRANSPLANTATION IN PATIENTS WITH FOCAL GLOMERULOSCLEROSIS: A ONE‐CENTER STUDY OF PLASMA EXCHANGE EFFECTS , 1991, Transplantation.

[6]  C. Ponticelli,et al.  The recurrence of focal segmental glomerulosclerosis in kidney transplant patients treated with cyclosporine. , 1990, Transplantation.

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

[8]  D. Norman.  An overview of the use of the monoclonal antibody OKT3 in renal transplantation. , 1988, Transplantation Proceedings.

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

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

[11]  S. Garella,et al.  Use of single voided urine samples to estimate quantitative proteinuria. , 1983, The New England journal of medicine.

[12]  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.

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

[14]  R. Fine,et al.  Focal glomerulosclerosis in renal allografts: association with the nephrotic syndrome and chronic rejection. , 1977, American journal of diseases of children.

[15]  M. Susin,et al.  Kidney transplant nephrotic syndrome. , 1974, The American journal of medicine.

[16]  G. Abouna,et al.  Massive early proteinuria following renal homotransplantation. , 1973, JAMA.

[17]  C. Uys,et al.  Massive proteinuria after renal transplantation. A case report. , 1971, South African journal of surgery. Suid-Afrikaanse tydskrif vir chirurgie.

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