title: Isometric tubular vacuolization in renal transplant recipient: the first case report in Thailand.
abstract: Cyclosporine can cause acute and chronic nephrotoxicity. Renal biopsy is a reliable tool for the diagnosis of cyclosporine nephrotoxicity. The authors report a 56-year-old Thai female with a history of end-stage renal disease who underwent cadaveric renal transplantation. A transplanted kidney biopsy was performed on day 9 post-transplant to identify the cause of delayed graft function. Light and electron microscopic findings revealed widespread (> 50% involvement) numerous tubules filled with uniformly-sized vacuoles in cytoplasm (isometric vacuolization). Serum cyclosporine trough level was 534 ng/mL. Neither acute rejection nor acute tubular necrosis was seen. Diagnosis of acute cyclosporine nephrotoxicity was made. Isometric vacuolization in more than 50% involvement of the tubules is rare (3%) in biopsy specimens. The tubular isometric vacuolization might not have the strong impact to the long term graft outcome. This is the first case report of isometric tubular vacuolization due to cyclosporine toxicity in renal transplant recipient in Thailand.
authors.affiliation: Division of Nephrology, Department of Medicine, Phramongkutklao Hospital, Bangkok, Thailand. prajej@gmail.com
authors.forename: Prajej
authors.initials: P
authors.lastname: Ruangkanchanasetr
authors.forename: Weerasak
authors.initials: W
authors.lastname: Praechinavong
authors.forename: Paisit
authors.initials: P
authors.lastname: Paueksakon
authors.forename: Bancha
authors.initials: B
authors.lastname: Satirapoj
authors.forename: Ouppatham
authors.initials: O
authors.lastname: Supasyndh
authors.forename: Thanom
authors.initials: T
authors.lastname: Supaporn
mesh_terms: D001706:Biopsy; D016572:Cyclosporine / Q000009:adverse effects*; D005260:Female; D006801:Humans; D007166:Immunosuppressive Agents / Q000009:adverse effects*; D016030:Kidney Transplantation / Q000473:pathology*; D007683:Kidney Tubular Necrosis, Acute / Q000139:chemically induced*; D007684:Kidney Tubules / Q000473:pathology; D008875:Middle Aged; D013785:Thailand; D014617:Vacuoles / Q000473:pathology
chemical_list: D007166:Immunosuppressive Agents; D016572:Cyclosporine