title: Myoglobin cast nephropathy in a kidney transplant patient with normal creatine kinase.
abstract: Delayed graft function in kidney transplant recipients is a known complication associated with increased risk of acute rejection and reduced transplant survival after 1 year. There are multiple risk factors, including prolonged cold ischemia time, donor age, and cause of donor's death. Major causes of delayed graft function are acute kidney injury in the donor, often from prolonged terminal ischemia, reflected by acute tubular injury in the recipient. However, the differential diagnosis of delayed graft function includes acute rejection, recurrence of the primary glomerular diseases, and other less commonly encountered conditions. A transplant kidney biopsy usually is required to elucidate the correct cause and initiate the right treatment, which is crucial for transplant survival. We report a case of a transplant recipient who developed delayed graft function due to an uncommon cause. After correct diagnosis, the patient's transplant function improved.
authors.affiliation: Department of Pathology, Microbiology and Immunology, Vanderbilt University School of Medicine, Nashville, TN.
authors.forename: Elissa
authors.initials: E
authors.lastname: Oliveira da Fonseca
authors.affiliation: Division of Nephrology and Hypertension, Department of Medicine, Vanderbilt University School of Medicine, Nashville, TN.
authors.forename: Arksarapuk
authors.initials: A
authors.lastname: Jittirat
authors.affiliation: Division of Nephrology and Hypertension, Department of Medicine, Vanderbilt University School of Medicine, Nashville, TN.
authors.forename: Kelly A
authors.initials: KA
authors.lastname: Birdwell
authors.affiliation: Department of Pathology, Microbiology and Immunology, Vanderbilt University School of Medicine, Nashville, TN; Division of Nephrology and Hypertension, Department of Medicine, Vanderbilt University School of Medicine, Nashville, TN. Electronic address: agnes.fogo@vanderbilt.edu.
authors.forename: Agnes B
authors.initials: AB
authors.lastname: Fogo
mesh_terms: D000328:Adult; D015415:Biomarkers / Q000097:blood; D001706:Biopsy; D003402:Creatine Kinase / Q000097:blood*; D051799:Delayed Graft Function / Q000175:diagnosis / Q000378:metabolism; D003937:Diagnosis, Differential; D005260:Female; D006084:Graft Rejection / Q000175:diagnosis / Q000378:metabolism; D006085:Graft Survival; D006801:Humans; D007668:Kidney / Q000378:metabolism / Q000473:pathology*; D007674:Kidney Diseases / Q000175:diagnosis* / Q000378:metabolism* / Q000473:pathology; D007676:Kidney Failure, Chronic / Q000601:surgery*; D016030:Kidney Transplantation; D009211:Myoglobin / Q000378:metabolism*; D016896:Treatment Outcome
chemical_list: D015415:Biomarkers; D009211:Myoglobin; D003402:Creatine Kinase
keywords: Myoglobin cast nephropathy; acute tubular injury; creatine kinase; creatine phosphokinase; delayed graft function; electron-dense casts; kidney donation after cardiac death; kidney transplant; renal biopsy; rhabdomyolysis