Focal segmental glomerulosclerosis after renal transplantation in a child with ANCA-associated glomerulonephritis: case report and literature review
10.3760/cma.j.issn.0578-1310.2016.12.013
- VernacularTitle:抗中性粒细胞胞质抗体相关性肾炎患儿肾移植术后新发局灶节段性肾小球硬化一例并文献复习
- Author:
Liping RONG
1
;
Lizhi CHEN
;
Qian FU
;
Fang Wen CHEN
;
Liangzhong SUN
;
Xiaoyun JIANG
;
Ying MO
Author Information
1. 中山大学附属第一医院儿科
- Keywords:
Antibodies,antineutrophilcytoplasmic;
Glomerulonephritis;
Kidney transplantation;
Glomerulosclerosis,focal segmental;
Plasma exchange
- From:
Chinese Journal of Pediatrics
2016;54(12):936-940
- CountryChina
- Language:Chinese
-
Abstract:
Objective To study the clinical features and treatment of focal segmental glomerulosclerosis (FSGS) after renal transplantation in a child with ANCA-associated glomerulonephritis.Method The clinical and pathological data of the patient treated in the Department of Pediatrics as well as in the Department of Organ Transplantation in November 2015 in the First Affiliated Hospital of Sun Yat-sen University,who was diagnosed with de novo FSGS after renal transplantation with a primary disease ANCA-associated glomerulonephritis,was analyzed retrospectively.Reports on " ANCA-associated glomerulonephritis (renal OR kidney) transplantation focal segmental glomerular sclerosis " were searched and reviewed.Result A ten years old female was definitely diagnosed with ANCA-associated glomerulonephritis on the 81st day after the onset of primary ANCA associated glomerulonephritis.Because of progressive decline of renal function,a hemodialysis period for 7 months was administered following the pulsed methylprednisolone as well as cyclophosphamide treatment.The renal transplantation was then carried out 18 months later,the renal function recovered 7 days later while proteinuria reappeared 28 days after renal transplantation.Based on the anti-rejection treatment,3 times pulsed methylprednisolone administration did not make difference on reducing the proteinuria and then a renal biopsy was conducted and the transplanted kidney proved to be a newly developed FSGS.Consequently,plasma exchange therapy was administrated.When the plasma exchange course finished,the proteinuria decreased significantly (from 3.270 g/24 h to 0.370 g/24 h).No reports were retrieved either in Chinese databases or at PubMed as well as Medline databases.Conclusion FSGS appears in transplanted kidney in patient with a primary renal disease as ANCA associated glomerulonephritis with early proteinuria after transplantation as well as negative P-ANCA and MPO.Pathology of renal biopsy revealed FSGS while the pathology of other recipient was not FSGS.The patient had no response to pulsed methylprednisolone therapy.Instead,plasma exchange therapy was an alternative also effective treatment for de novo FSGS in transplanted kidney.
