Renal Biopsy Findings of Prospective Kidney Donors and Clinical Course of Renal Allografts / 대한이식학회지

PURPOSE: To evaluate the pathology of prospective kidney donors and assess the clinical outcomes of the renal allografts. METHODS: We reviewed the records of 12 prospective kidney donors who underwent kidney biopsy. The indications of kidney biopsy were asymptomatic microscopic hematuria (n=88, 66.7%), decreased glomerular filtration rate (GFR, n=22, 16.7%), mild proteinuria (n=11, 8.3%), history of gross hematuria (n=11, 8.3%). RESULTS: Kidney biopsy in 8 prospective donors with asymptomatic microscopic hematuria showed: 5 (62.5%) thin basement membrane disease (TBMD); 1 IgA nephropathy; 1 Alport's syndrome; 1 mild mesangial widening. Two prospective donors with decreased GFR showed IgA nephropathy and tubulointerstitial lesion. The one with mild proteinuria showed arterionephrosclerosis and the one with a history of gross hematuria showed tubulointerstitial lesion. 4 (33.3%) of the 12 who underwent kidney biopsy were accepted as kidney donors.; 3 donors with TBMD and the donor with mild mesangial widening, who all had microscopic hematuria. Among the 4 donations, there was 1 graft failure and 3 allografts (1 mild mesangial widening, 2 TBMD) have maintained graft function at latest follow up. CONCLUSION: The most common cause of asymptomatic microscopic hematuria in prospective kidney donors was TBMD. Long-term follow up is needed to assess the clinical outcomes of these allografts.

Spontaneous Cauda Equina Syndrome in a Renal Transplant Patient with Long-term Azathioprine Treatment / 대한이식학회지

Azathioprine is a conventional immunosuppressant in renal transplantation but long-term administration may lead to hematologic complications. We here report a cauda equina syndrome caused by spontaneous epidural hematoma in a renal transplant recipient who had undergone long-term azathioprine treatment. A 34 year-old male was admitted to our hospital with complaints of numbness of the lower extremities and back pain. He had received renal transplantation 14 years ago and had been on sole therapy with azathioprine for 11 years. Three months before admission, the patient developed pancytopenia, and a subsequent bone marrow biopsy revealed hypocellularity. Azathioprine was replaced by tacrolimus and steroids thereafter. After a three months discontinuation of azathioprine, an epidural hematoma developed and resulted in cauda equina syndrome. Regular follow-up of complete blood count and change of immunosuppressants with less bone marrow toxicity should be considered in patients receiving azathioprine for long-term period.

A Fat Density Mass in the Mediastinum / 결핵및호흡기질환

A 47-year-old female was admitted for an evaluation of a left mediastinal mass. The chest X-ray performed 16 months ago was normal, but the chest X-ray upon admission showed a large mass adjacent to the anterior aspect of the left hemidiaphragm. The CT scan demonstrated a large mass with a fat density in the left lower hemithorax. A focal diaphragmatic defect behind the xiphoid process was suspected. A thoracoscopic examination revealed omental herniation through the diaphragmatic defect. Therefore, a left thoracotomy was performed and the defect was repaired. We believe that a differential diagnosis should be needed to include a diaphragmatic omental hernia when a fat density mass is observed in the mediastinum.

A Case of Pulmonary Cryptococcosis in an Immunocompetent Patient / 결핵및호흡기질환

We experienced a case of pulmonary cryptococcosis in an immunocompetent patient who presented with uncommon radiological findings. He complained of a dry cough for 3 weeks. The chest X-ray and CT showed multiple, variable sized, and irregular patch consolidations with cavities combined with some ground glass opacities in both lower lung fields. The diagnosis was made histologically via a thoracoscopic lung biopsy. The patient was administered oral fluconazole has since been well.