title: Overlapped glomerular lesions of chronic rejection and recurrent lupus nephritis in transplanted kidney: a case report.
abstract: We describe a renal transplant recipient with systemic lupus erythematosus (SLE) who showed continuous proteinuria and low complement levels without clinical evidence of active SLE. Her first renal allograft biopsy, performed nine yr and eight months after transplantation, revealed unusual histological change of glomeruli, and it initially led us to make a contradictory diagnosis based on light and electron microscopic examinations. Diffuse global double- or multi-contour glomerular basement membrane was caused by chronic endothelial injury owing to chronic rejection, and mesangial proliferation associated with mesangial electron-dense deposit was a histological change characteristic of recurrent lupus nephritis (RLN). Immunofluorescence study displayed weak mesangial staining of IgM and C1q. We concluded that this case presented overlapped chronic rejection and RLN. Because both transplant nephropathy and lupus nephritis present constellations of various histologies, it is difficult to diagnose their overlap. Complete morphologic studies with both immunofluorescence and electron microscopic evaluations in addition to microscopic examination should be performed to elucidate complex histological findings.
authors.affiliation: Department of Surgical Pathology, Graduate School of Medical Science, Kamigyo-Ku, Kyoto, Japan. nao7038masu@yahoo.co.jp
authors.forename: Naoko
authors.initials: N
authors.lastname: Masuzawa
authors.forename: Koji
authors.initials: K
authors.lastname: Urasaki
authors.forename: Masahiko
authors.initials: M
authors.lastname: Okamoto
authors.forename: Shuji
authors.initials: S
authors.lastname: Nobori
authors.forename: Hidetaka
authors.initials: H
authors.lastname: Ushigome
authors.forename: Norio
authors.initials: N
authors.lastname: Yoshimura
authors.forename: Akio
authors.initials: A
authors.lastname: Yanagisawa
mesh_terms: D000328:Adult; D002908:Chronic Disease; D015922:Complement C1q / Q000276:immunology; D005260:Female; D015433:Glomerulonephritis, Membranous / Q000175:diagnosis / Q000209:etiology*; D006084:Graft Rejection / Q000175:diagnosis / Q000209:etiology*; D006801:Humans; D016030:Kidney Transplantation / Q000009:adverse effects*; D008180:Lupus Erythematosus, Systemic / Q000150:complications / Q000628:therapy*; D008181:Lupus Nephritis / Q000175:diagnosis / Q000209:etiology*; D011507:Proteinuria; D012008:Recurrence
chemical_list: D015922:Complement C1q