title: Rapamycin-associated post-transplantation glomerulonephritis and its remission after reintroduction of calcineurin-inhibitor therapy.
abstract: Rapamycin is a new immunosuppressive agent approved for maintenance therapy after kidney transplantation. It may allow calcineurin-inhibitor-free, non-nephrotoxic immunosuppression. We report, however, on four kidney-transplant recipients who developed post-transplantation glomerulonephritis after conversion from a calcineurin-inhibitor-based immunosuppression to rapamycin. In all four patients nephrotic-range proteinuria occurred 2-9 months after conversion to rapamycin. Renal biopsy confirmed membrano-proliferative glomerulonephritis type 1 in one case, membranous glomerulonephritis in another and IgA-nephropathy in two cases, respectively. Calcineurin-inhibitor-based immunosuppression was reintroduced and resulted in complete remission of proteinuria and in stabilised renal function in all patients. We conclude that in the case of rapamycin-associated post-transplantation glomerulonephritis an attempt should be made to replace rapamycin by a calcineurin inhibitor.
authors.affiliation: Department of Medicine III, Division of Nephrology and Dialysis, University of Vienna, 1090 Vienna, Austria.
authors.forename: Elisabeth
authors.initials: E
authors.lastname: Dittrich
authors.forename: Sabine
authors.initials: S
authors.lastname: Schmaldienst
authors.forename: Afschin
authors.initials: A
authors.lastname: Soleiman
authors.forename: Walter H
authors.initials: WH
authors.lastname: Hörl
authors.forename: Erich
authors.initials: E
authors.lastname: Pohanka
mesh_terms: D000328:Adult; D019703:Calcineurin / Q000627:therapeutic use; D065095:Calcineurin Inhibitors; D003401:Creatine / Q000097:blood; D005260:Female; D005921:Glomerulonephritis / Q000097:blood / Q000139:chemically induced* / Q000473:pathology; D006801:Humans; D007166:Immunosuppressive Agents / Q000009:adverse effects*; D016030:Kidney Transplantation; D008297:Male; D008875:Middle Aged; D011507:Proteinuria / Q000139:chemically induced; D020123:Sirolimus / Q000009:adverse effects*; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D065095:Calcineurin Inhibitors; D007166:Immunosuppressive Agents; D019703:Calcineurin; D003401:Creatine; D020123:Sirolimus