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1.
Transpl Infect Dis ; 15(5): 526-32, 2013 Oct.
Article in English | MEDLINE | ID: mdl-23947513

ABSTRACT

Microsporidia are opportunistic pathogens that usually cause a limited disease in the gastrointestinal tract. Occasionally, they can cause disseminated disease. In solid organ transplant recipients, disseminated disease has been reported only rarely. We describe a 68-year-old woman who presented with fever, cough, and acute kidney injury 6 months after kidney transplantation. Dissemination was confirmed by identification of microsporidial spores in urine and bronchoalveolar lavage fluid. Polymerase chain reaction analysis identified the species as Encephalitozoon cuniculi.


Subject(s)
Encephalitozoon cuniculi/isolation & purification , Encephalitozoonosis/diagnosis , Immunocompromised Host , Kidney Transplantation/adverse effects , Opportunistic Infections , Aged , Bronchoalveolar Lavage Fluid/microbiology , Encephalitozoon cuniculi/genetics , Encephalitozoonosis/complications , Encephalitozoonosis/microbiology , Female , Humans , Kidney/pathology , Spores, Fungal , Treatment Outcome
2.
Am J Transplant ; 12(4): 1029-38, 2012 Apr.
Article in English | MEDLINE | ID: mdl-22233329

ABSTRACT

We assessed the earliest manifestations of recurrent membranous glomerulonephritis (MGN) in renal allografts. Clinical, laboratory and pathologic data were reviewed in 21 patients at the initial biopsy within 4 months post-transplant with evidence of MGN and on follow-up biopsies, compared to a biopsy control group of eight transplants without recurrent MGN. The mean time of first biopsy with pathologic changes was 2.7 months. In each earliest biopsy, immunofluorescence (IF) showed granular glomerular basement membrane (GBM) staining for C4d, IgG, kappa and lambda. IF for C3 was negative or showed trace staining in 16/21. On each MGN biopsy positive by IF, 14/19 showed absence of deposits or rare tiny subepithelial deposits by electron microscopy (EM). At the earliest biopsy, the mean proteinuria was 1.1 g/day; 16 patients had <1 g/day proteinuria. Follow-up was available in all patients (mean 35 months posttransplant). A total of 13 patients developed >1 g/day proteinuria; 12 were treated with: rituximab (n = 8), ACEI and increased prednisone dose (n = 2), ACEI or ARB only (n = 2). All patients showed reduction in proteinuria after treatment. A total of 11/16 patients showed progression of disease by EM on follow-up biopsy. Recognition of early allograft biopsy features aids in diagnosis of recurrent MGN before patients develop significant proteinuria.


Subject(s)
Glomerulonephritis, Membranous/etiology , Glomerulonephritis, Membranous/pathology , Kidney Diseases/surgery , Kidney Transplantation/adverse effects , Postoperative Complications , Adult , Aged , Antibodies, Monoclonal, Murine-Derived/therapeutic use , Female , Fluorescent Antibody Technique , Follow-Up Studies , Glomerulonephritis, Membranous/drug therapy , Humans , Immunologic Factors/therapeutic use , Kidney Diseases/complications , Male , Middle Aged , Prognosis , Proteinuria/drug therapy , Proteinuria/etiology , Proteinuria/pathology , Recurrence , Retrospective Studies , Rituximab , Transplantation, Homologous
3.
Am J Transplant ; 11(3): 606-12, 2011 Mar.
Article in English | MEDLINE | ID: mdl-21342449

ABSTRACT

We report four cases of de novo amyloidosis occurring after 16, 18, 28 and 31 years following kidney transplantation. These patients presented with proteinuria and progressive allograft dysfunction. Kidney biopsy showed AL amyloidosis in all compartments of the allograft kidney. Serum immunofixation studies revealed monoclonal lambda light chains in all four cases. Bone marrow examination showed 10% plasma cells in one case, 5-10% in two cases and less than 5% in one case. Two patients died unexpectedly within 3 months and 1 year of the diagnosis of allograft AL amyloidosis. Of the remaining two, one underwent autologous stem cell transplant that resulted in complete hematologic remission. However, the patient relapsed within 2 years and also developed progressive kidney allograft failure. The patient received a second autologous stem cell transplant with complete hematologic response, followed by a second kidney transplant, which showed no evidence of amyloid at 1-year posttransplant. The remaining case was treated with prednisone and bortezomib, which has stabilized kidney function in the short term. In conclusion, this study shows that AL amyloidosis is an uncommon but important cause of late onset proteinuria in the kidney allograft that results in kidney allograft failure.


Subject(s)
Amyloidosis/etiology , Amyloidosis/therapy , Kidney Transplantation/adverse effects , Amyloidosis/diagnosis , Antineoplastic Combined Chemotherapy Protocols/therapeutic use , Boronic Acids/administration & dosage , Bortezomib , Female , Hematopoietic Stem Cell Transplantation , Humans , Male , Melphalan/administration & dosage , Middle Aged , Prednisone/administration & dosage , Proteinuria/diagnosis , Proteinuria/etiology , Proteinuria/therapy , Pyrazines/administration & dosage , Remission Induction , Treatment Outcome
11.
Transplant Proc ; 38(10): 3384-7, 2006 Dec.
Article in English | MEDLINE | ID: mdl-17175278

ABSTRACT

INTRODUCTION: Our center has recently observed foreign carbohydrate-appearing particles (FP) on transplant postreperfusion biopsy specimens: (PRBx). METHODS: To further characterize FPs, we reviewed all renal transplant RBx (30-45 minutes) performed between September 1, 2004 and December 3, 2005. Donor, preservation, and outcome variables were collected among patients with FP. RESULTS: A total of 135 PRBx were performed (45 deceased donors [DD] and 90 live donors [LD]). Fifteen PRBx demonstrated FP. All 15 cases were DD kidneys that underwent machine perfusion (MP) on the Waters RM3 (Waters Medical Systems, Rochester, Minn, United States) with Belzer MP solution (Trans Med, Elk River, Minn, United States). Donor age was 39.8 +/- 15.7 years. Terminal creatinine level was 1.45 +/- 0.8 mg/dL. Two of 15 were flushed in situ with HTK solution (no starch). Cold ischemia time was 28.8 +/- 9.1 hours with 14.3 +/- 5.1 hours of MP. In 13 of 15 patients, perfusion parameters were excellent (flow > 100 mL; resistance < .35). CHARACTERISTICS OF FP: Particles were 10-30 mu and globular in shape. FP were not visible on hematoxylin and eosin stain, but stained strongly periodic acid-Schiff-(PAS) positive and were refractile under polarized light. FP were seen segmentally within glomerular capillaries in all cases and in peritubular capillaries in 3. In 11 of the 15 cases with FP, focal glomerular fibrin thrombi or intracapillary neutrophil margination was seen. Ten of 15 patients with FP had a biopsy within the first week with no identifiable FP. OUTCOMES: Recipient age was 45.3 +/- 11.6 years. Eight patients (53.3%) had delayed graft function. Biopsy-proven rejection occurred in 3 patients (20%). Three-month creatinine level was 1.59 +/- 0.35 mg/dL. One graft was lost to early thrombosis in a patient with a hypercoagulable state and 1 patient died of sepsis at 2 months. All remaining 13 patients are alive with excellent graft function at a median follow-up of 6.7 months (range, 3-17 months). CONCLUSIONS: Microscopic intrarenal particles may be seen on DD kidney PRBx after MP. These FPs likely originate from surgical gloves. FPs are too small to be captured by standard filters but clear spontaneously and do not have deleterious effects on renal function or outcomes.


Subject(s)
Kidney Transplantation/pathology , Organ Preservation/methods , Adult , Biopsy , Cadaver , Carbohydrates/analysis , Creatinine/blood , Follow-Up Studies , Foreign Bodies/pathology , Humans , Kidney Glomerulus/cytology , Kidney Glomerulus/ultrastructure , Kidney Transplantation/physiology , Living Donors , Middle Aged , Time Factors , Tissue Donors , Treatment Outcome
13.
Kidney Int ; 70(12): 2148-51, 2006 Dec.
Article in English | MEDLINE | ID: mdl-17063172

ABSTRACT

Direct immunofluorescence (IF) on frozen tissue is the method of choice for the study of medical renal diseases. When no glomeruli are available, IF can be performed on the formalin-fixed paraffin-embedded tissue allocated for light microscopy after antigen retrieval with proteases. In this study, the results of IF on frozen tissue (IF-F) and on deparaffinized, pronase-treated tissue (IF-P) were compared in 71 renal biopsies representing 12 major renal diseases. Using IF-P, diagnostic findings were obtained in 100% of cases of lupus nephritis, acute post-infectious glomerulonephritis, cryoglobulinemic glomerulonephritis, fibrillary glomerulonephritis, primary amyloidosis, myeloma cast nephropathy, and light-chain Fanconi syndrome (LCFS), 88% of cases of immunoglobulin (Ig)A nephropathy, 80% of cases of light-chain deposition disease, 60% of cases of membranoproliferative glomerulonephritis type 1, 50% of cases of idiopathic membranous glomerulopathy (MGN) and 20% of cases of anti-glomerular basement membrane (GBM) disease. IF-P was less sensitive than IF-F for the detection of C3 in all disease categories and for the detection of IgG in cases of MGN and anti-GBM disease. The diagnostic kappa light-chain staining was demonstrated in 100% of cases of LCFS by IF-P versus 40% by IF-F. We conclude that IF-P is a valuable salvage immunohistochemical technique for renal biopsies lacking adequate cortical sampling for IF-F, and is superior to IF-F for the diagnosis of LCFS.


Subject(s)
Fluorescent Antibody Technique/methods , Kidney Diseases/pathology , Kidney/pathology , Paraffin Embedding , Pronase , Antigen-Antibody Complex , Biopsy , Frozen Sections , Humans , Immunoglobulin G , Immunoglobulin kappa-Chains , Kidney/immunology , Kidney Diseases/immunology , Sensitivity and Specificity
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