Acute transplant glomerulopathy with monocyte rich infiltrate.
Acute transplant glomerulopathy refers to alloimmune mediated endothelial injury and glomerular inflammation that typically occurs early post-kidney transplantation. We report a case of a 48-year old woman with end stage renal disease from lupus nephritis who developed an unexplained rise in serum creatinine 2 months after renal transplant. As immunosuppression, she received alemtuzumab induction followed by a tacrolimus, mycophenolate mofetil and prednisone maintenance regimen. Her biopsy revealed severe glomerular endothelial injury associated with monocyte/macrophage-rich infiltrate in addition to mild acute tubulointerstitial cellular rejection. We briefly discuss acute transplant glomerulitis, its pathology and association with chronic/overt transplant glomerulopathy, C4d negative antibody-mediated rejection and the significance of monocytes in rejection. We also postulate that alemtuzumab induction may have contributed to the unusual pattern of monocyte-rich transplant glomerulitis.
Department of Medicine, Nephrology Division, Stanford University Medical Center, Stanford, CA, United States.
Colin R
CR
Lenihan
Jane C
JC
Tan
Neeraja
N
Kambham
D000208:Acute Disease; D064591:Allografts; D005260:Female; D015433:Glomerulonephritis, Membranous / Q000139:chemically induced* / Q000188:drug therapy / Q000473:pathology*; D006084:Graft Rejection / Q000139:chemically induced* / Q000276:immunology / Q000473:pathology* / Q000517:prevention & control; D006801:Humans; D007166:Immunosuppressive Agents / Q000008:administration & dosage / Q000009:adverse effects*; D016030:Kidney Transplantation; D008181:Lupus Nephritis / Q000276:immunology / Q000473:pathology / Q000601:surgery; D008875:Middle Aged; D009000:Monocytes / Q000276:immunology / Q000473:pathology*
D007166:Immunosuppressive Agents
Acute transplant glomerulopathy; Alemtuzumab; Kidney transplantation; Macrophage; Monocyte; Transplant glomerulitis