Myeloma cast nephropathy: a rare cause of primary renal allograft dysfunction.

We describe a rare case of primary renal allograft dysfunction due to myeloma cast nephropathy in a patient with no prior history of multiple myeloma preceding her transplantation. A 72-year-old woman on hemodialysis for 4 years prior to transplantation due to presumed hypertensive nephrosclerosis developed immediate graft dysfunction posttransplantation. The graft biopsy specimens were consistent with myeloma cast nephropathy for which she was treated with plasmapheresis and chemotherapy using bortezomib and dexamethasone. She achieved partial hematologic remission and recovered excellent graft function by 3 months posttransplantation. This is the first report of successful recovery of renal allograft function after development of cast nephropathy.

Effect of biocompatibility of hemodialysis membranes on serum albumin levels.

Hypoalbuminemia in end-stage renal disease is a marker of high morbidity and mortality. In some patients, the cause of low serum albumin levels is easily identified and therefore treatable, but in many patients, the cause is not clear. We studied the effect of changing the dialysis membrane from a bioincompatible to a biocompatible membrane on serum albumin level. Stable hemodialysis patients dialyzed with cuprammonium membranes who had serum albumin levels less than 3.5 g/dL were switched to the more biocompatible membrane, polysulfone. Serum albumin levels increased from 3.22 +/- 0.037 to 3.35 +/- 0.038 g/dL (mean +/- SE; P < 0.002). The increase was seen in patients both with and without diabetes. Thus, dialyzer membrane may affect serum albumin levels and should be considered in the differential diagnosis of hypoalbuminemia in patients undergoing hemodialysis with bioincompatible membranes. Membrane choice may have an important effect on the outcome of morbidity and mortality of hemodialysis patients.

Pulmonary mucormycosis in diabetic renal allograft recipients.

Renal allograft recipients are prone to opportunistic infections due to their need of immunosuppression to prevent rejection. Mucormycosis is a rare opportunistic infection caused by a fungi of the order Mucorales. Risk factors predisposing to this disease include prolonged neutropenia, chelation therapy for iron or aluminum overdose, diabetes, and patients who are immunosuppressed. Life-threatening infections can occur, as this fungi has the propensity to invade blood vessel endothelium, resulting in hematologic dissemination. Early diagnosis and prompt aggressive therapy is imperative to achieve an improved outcome. We present two cases of pulmonary mucormycosis in diabetic renal allograft recipients who were treated successfully with amphotericin B and surgical resection of the lesions with preservation of their allograft function. In this era of intensified immunosuppression, we may see an increased incidence of mucormycosis in our transplant population.