Recurrent lupus nephritis in the second allograft of a patient with systemic lupus erythematosus.
Lupus glomerulonephritis is a common and serious complication of systemic lupus erythematosus (SLE) affecting up to 50% of lupus patients. Recurrent lupus nephritis is rare, complicating as low as 1% of the lupus transplant population according to some authors. However, it may be underreported with more realistic recurrent rates oscillating from 2.8 to 8.7%. We report the case of a patient with SLE who lost her first allograft 4 years after transplantation with a diagnosis of de novo fibrillary glomerulopathy. She underwent a second renal transplantation and her renal function was stable for the past 5 years. She now presented with skin rash, arthralgias and positive lupus serologies. Her creatinine was slightly elevated and proteinuria was also noted. A renal biopsy performed revealed a recurrent focal proliferative lupus nephritis (WHO III). Retrospectively, we believe that her first allograft was also lost to recurrent lupus nephritis. This is a unique case of recurrent lupus nephritis in the second allograft of a patient with SLE.
Isaac
Jorge
J
Anatomical/Renal Pathology, University of Utah Health Sciences Center and ARUP Laboratories, Salt Lake City, Utah 84132, USA. jorge.isaac@path.utah.edu
Shihab
Fuad S
FS
D000328:Adult; D003176:Complement C3 / Q000378:metabolism; D005260:Female; D006801:Humans; D016030:Kidney Transplantation; D008180:Lupus Erythematosus, Systemic / Q000150:complications*; D008181:Lupus Nephritis; D012008:Recurrence; D014184:Transplantation, Homologous
D003176:Complement C3