title: Diagnosis of de novo localized thrombotic microangiopathy by surveillance biopsy.
abstract: Thrombotic microangiopathy has been reported in association with calcineurin inhibitors and less frequently with sirolimus in renal transplant patients. The diagnosis of thrombotic microangiopathy is typically made by diagnostic biopsy in the setting of allograft dysfunction. The finding of thrombotic microangiopathy on surveillance biopsy without a significant elevation of baseline serum creatinine is unusual. The optimal treatment of this disorder remains controversial. Treatment strategies have included dose adjustment, drug substitution, plasmapheresis, and intravenous immunoglobulin G. We report a case of de novo thrombotic microangiopathy diagnosed by surveillance biopsy in a patient without hematologic abnormalities or elevated serum creatinine. This patient had resolution of the renal lesion following conversion from tacrolimus to sirolimus-based immunosuppression.
authors.affiliation: Department of Pediatrics, University of Tennessee Health Science Center (UTHSC), Memphis, TN, USA. mhasting@utmem.edu
authors.forename: M Colleen
authors.initials: MC
authors.lastname: Hastings
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Wyatt
authors.forename: Bettina H
authors.initials: BH
authors.lastname: Ault
authors.forename: Deborah P
authors.initials: DP
authors.lastname: Jones
authors.forename: Keith K
authors.initials: KK
authors.lastname: Lau
authors.forename: A Osama
authors.initials: AO
authors.lastname: Gaber
authors.forename: Lillian W
authors.initials: LW
authors.lastname: Gaber
mesh_terms: D000293:Adolescent; D001706:Biopsy; D002196:Capillaries / Q000473:pathology*; D003404:Creatinine / Q000097:blood; D006801:Humans; D007166:Immunosuppressive Agents / Q000009:adverse effects / Q000627:therapeutic use; D016030:Kidney Transplantation / Q000473:pathology*; D008297:Male; D012079:Renal Circulation; D020123:Sirolimus / Q000009:adverse effects; D016559:Tacrolimus / Q000627:therapeutic use; D013927:Thrombosis / Q000473:pathology*; D016896:Treatment Outcome
chemical_list: D007166:Immunosuppressive Agents; D003404:Creatinine; D020123:Sirolimus; D016559:Tacrolimus