title: Recurrence of anti-neutrophil cytoplasmic antibody-associated vasculitis in appropriately immunosuppressed renal transplant patients: a discussion of two cases.
abstract: BACKGROUND
  Granulomatosis with polyangiitis (GPA) (formerly known as Wegener's granulomatosis) is a multisystem autoimmune disease of unknown aetiology. Renal disease manifests as a crescentic glomerulonephritis, with varying degrees of renal failure. Ten percent of patients progress to end-stage kidney disease. Relapse of GPA in renal transplant patients is rare, with a rate of 0.09 relapses per patient per year.
  
  
  METHODS
  We describe two cases of GPA relapse in immunosuppressed renal transplant patients.
  
  
  RESULTS
  These patients presented with new-onset graft disfunction, having previously had an uncomplicated posttransplant course. Both patients were on appropriate doses of immunosuppressive agents at the time of relapse, with therapeutic target levels of tacrolimus. We describe the background history and management of both patients.
  
  
  CONCLUSIONS
  The cases described inform us that although recurrence of anti-neutrophil cytoplasmic antibody vasculitis in transplant patients is rare, it should remain on our list of differential diagnoses in allograft disfunction.
authors: Department of Nephrology, Beaumont Hospital, Dublin, Limerick, Ireland.
authors: Frank J
authors: FJ
authors: O'Brien
authors: Ahad
authors: A
authors: Abdalla
authors: Limy
authors: L
authors: Wong
authors: Carol A
authors: CA
authors: Traynor
authors: Paul
authors: P
authors: Cheriyan
authors: Hong Kwan
authors: HK
authors: Kok
authors: Liam
authors: L
authors: Casserly
authors: Anthony
authors: A
authors: Dorman
authors: Peter J
authors: PJ
authors: Conlon
keywords: Anti-neutrophil cytoplasmic antibody vasculitis; Disease recurrence; Renal transplantation