title: Post-transplant immune complex nephritis in a patient with systemic lupus erythematosus associated with ANCA vasculitis.
abstract: Nearly 20% of SLE corresponds to the pediatric population, and 75% of them have kidney involvement representing an important etiology of chronic kidney disease. A correlation between SLE and ANCA-associated vasculitis has been identified as an overlapping syndrome. Kidney allograft recurrence is rare in SLE when disease control is achieved and with nowadays immunosuppression treatment. Histologic transformation is unusual, especially when there are negative serologic markers and no immune complex deposition reported in native kidneys. A 17-year-old female with crescentic glomerulonephritis, p-ANCA-positive antibodies with pauci-immune pattern in kidney biopsy develops end-stage renal disease requiring hemodialysis. Deceased donor kidney transplant was performed receiving triple immunosuppression thereafter. Thirteen months later serum creatinine rises without evidence of infection, urinary obstruction, or clinical and serologic disease relapse. Allograft biopsy reports mesangial proliferation and "full-house" immunofluorescence. The role of ANCA in SLE physiopathology is controversial, and its relation with lupus nephritis is also discordant. ANCA could represent an important factor in the heterogeneity of systemic lupus erythematosus and lupus nephritis.
authors.affiliation: Resident of Pediatric Nephrology, National Institute of Pediatrics, México City, Mexico.
authors.forename: Carlos
authors.initials: C
authors.lastname: Sanchez
authors.affiliation: Resident of Pediatric Nephrology, National Institute of Pediatrics, México City, Mexico.
authors.forename: Alejandra
authors.initials: A
authors.lastname: Rebolledo
authors.affiliation: Resident of Pediatric Nephrology, National Institute of Pediatrics, México City, Mexico.
authors.forename: Junior
authors.initials: J
authors.lastname: Gahona
authors.affiliation: Anatomic-Pathology Department, National Institute of Pediatrics, México City, Mexico.
authors.forename: Mauricio
authors.initials: M
authors.lastname: Rojas
authors.affiliation: Pediatric Nephrology Department, National Institute of Pediatrics, México City, Mexico.
authors.forename: Raquel
authors.initials: R
authors.lastname: Jiménez
authors.affiliation: Pediatric Nephrology Department, National Institute of Pediatrics, México City, Mexico.
authors.forename: Aurora
authors.initials: A
authors.lastname: Bojórquez
mesh_terms: D000293:Adolescent; D056648:Anti-Neutrophil Cytoplasmic Antibody-Associated Vasculitis / Q000150:complications*; D000936:Antigen-Antibody Complex / Q000276:immunology; D001706:Biopsy; D005260:Female; D015432:Glomerulonephritis, Membranoproliferative / Q000209:etiology*; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D007668:Kidney / Q000473:pathology; D007676:Kidney Failure, Chronic / Q000150:complications*; D008180:Lupus Erythematosus, Systemic / Q000150:complications* / Q000276:immunology; D008181:Lupus Nephritis / Q000150:complications* / Q000276:immunology; D016896:Treatment Outcome; D014657:Vasculitis / Q000150:complications / Q000175:diagnosis / Q000276:immunology
chemical_list: D000936:Antigen-Antibody Complex; D007166:Immunosuppressive Agents
keywords: 
  ANCA
  ; kidney transplantation; lupus nephritis; systemic lupus erythematosus; vasculitis