Successful transplantation of a donor kidney with diffuse proliferative lupus nephritis and crescents--a case report.
Pre-existing diffuse proliferative glomerulonephritis (DPGN) in a potential deceased kidney donor has been considered a contraindication for transplantation. We report a case of a patient who underwent a successful deceased donor renal transplantation from a donor with history of systemic lupus erythematosus (SLE) whose baseline biopsy revealed DPGN. Although the histology was relatively benign in the procurement kidney biopsy done by frozen section, the final light microscopy available after transplantation showed diffuse proliferative lupus nephritis, WHO class IV, with 44% crescents. The post-transplant course was complicated by delayed allograft function requiring haemodialysis for the first week. A repeat biopsy performed after 4 months of transplant showed resolution of the proliferative lesions in the glomeruli with disappearance of the crescents. At 5.5 years of follow-up, the patient's creatinine has been stable at 2.0 mg/dL (176.8 μmol/L), but he has persistent proteinuria.
Magoon
Sandeep
S
Division of Nephrology, Department of Medicine, Montefiore Medical Center, Albert Einstein College of Medicine, NY, USA. sandeepmagoon@gmail.com
Zhou
Eric
E
Pullman
James
J
Greenstein
Stuart M
SM
Glicklich
Daniel G
DG
D000368:Aged; D001706:Biopsy; D003404:Creatinine / Q000378:metabolism; D005260:Female; D006085:Graft Survival; D006801:Humans; D007668:Kidney / Q000473:pathology*; D007676:Kidney Failure, Chronic / Q000601:surgery*; D016030:Kidney Transplantation / Q000473:pathology*; D008180:Lupus Erythematosus, Systemic / Q000150:complications; D008181:Lupus Nephritis / Q000175:diagnosis / Q000209:etiology / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D014019:Tissue Donors; D016896:Treatment Outcome
D003404:Creatinine