A 48-year-old woman with acute allograft dysfunction

Pedram Ahmadpoor, Mitra Mahdavi-Mazdeh, Mohsen Nafar, Fatemeh Pour-Reza-Gholi, Fariba Samadian, Mahmood Parvin
2010 Iranian Journal of Kidney Diseases  
Patient Dr Nafar: A 48-year-old lady was admitted 45 days after unrelated living kidney transplantation because of acute allograft dysfunction. She was on hemodialysis for 2 months before transplantation due to kidney failure caused by autosomal dominant polycystic kidney disease. The donor was a healthy 28-year-old man. Panel reactive antibodies test and cytotoxicity leukocyte cross-match were negative. The patient had been discharged 11 days after transplantation with a serum creatinine level
more » ... um creatinine level of 0.9 mg/dL. The immunosuppressive regimen consisted of cyclosporine, mycophenolate mofetil, and prednisolone. Seventeen days earlier, she was admitted to hospital because of increased serum creatinine to 1.78 mg/dL. She was treated with 3 doses of 500-mg methylprednisolone and cyclosporine dose reduction because of the high serum cyclosporine trough level (429 ng/mL). She was discharged after 7 days with a serum creatinine of 1.2 mg/dL. On this second posttransplant admission, she was febrile (body temperature, 38.5°C) and hypertensive (160/85 mm Hg). History and physical examinations were unremarkable, and no localized source of infection, organomegaly, lymphadenopathy, or skin rashes were found. There was no recent contact with febrile persons. The kidney allograft was not enlarged or tender. No abnormality was reported on chest radiography. Laboratory data are shown in the Table. Wide spectrum antibiotics and ganciclovir were started. The patient became afebrile within the next 24 hours. The results of blood and urine cultures for microorganisms, anti-human leukocyte antigen (HLA) antibodies, and cytomegalovirus antigenemia tests were negative. The trough level and 2-hour postdose level of cyclosporine were 270 ng/mL and 614 ng/mL, respectively. Ultrasonography revealed mild pyelocaliceal dilatation, and allograft diethylene triamine pentaacetic acid scan revealed some decrement in perfusion and function with no evidence of stasis or urinary leakage. On peripheral blood smear, there were about 4% schistocytes. Steroid pulse was administered, and cyclosporine was reduced to 50 mg, twice per day. A kidney
pmid:20622319 fatcat:r344psvsfjeydoghrqbsmhjqze