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      Hemolytic Uremic Syndrome Associated with Influenza A Virus Infection in an Adult Renal Allograft Recipient: Case Report and Review of the Literature

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          Hemolytic uremic syndrome (HUS) is a rare but serious complication following renal transplantation. It usually develops early after transplantation, and ciclosporin treatment is the most common triggering factor. We report the case of a 35-year-old male with posttransplant HUS which developed 1 year after renal transplantation. He became febrile 4 days before the onset of HUS, and the significant rise in viral titer confirmed the diagnosis of influenza A virus infection. The association of ciclosporin treatment with HUS was unlikely, because of the late onset of HUS and the low ciclosporin trough levels. The patient was treated successfully without a dose reduction of ciclosporin. An etiologic relationship between influenza A virus and HUS was highly probable in our patient. We also review a total of 156 adult cases with HUS after renal transplantation described in the literature. The prognosis of posttransplant HUS differs according to the cause. The advent of ciclosporin has improved the graft survival rate and mortality of patients with rejection-induced HUS.

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          Recurrent thrombotic thrombocytopenic purpura after viral infection. Clinical and histologic simulation of chronic glomerulonephritis.

          We describe a patient with recurrent thrombotic thrombocytopenic purpura (TTP) manifested solely by aphasia after influenza infection. The clinical diagnosis was not made during acute episodes, and during the intercurrent period the patient had features of chronic glomerular disease, including hypertension, proteinuria, RBC casts, and a nonspecific renal histological appearance. A final episode of aphasia, acute renal failure, and microangiopathic anemia and thrombocytopenia made the diagnosis of TTP apparent. Chronic glomerular disease may in rare instances be a manifestation of occult TTP or the sequel of a prior acute episode of this disorder.
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            Microvascular Changes in Renal Allografts Associated with FK506 (Tacrolimus) Therapy


              Author and article information

              S. Karger AG
              March 2000
              08 March 2000
              : 84
              : 3
              : 258-266
              aDivision of Nephrology, Department of Internal Medicine, and bDepartment of Urology, Kanazawa Medical University, Ishikawa, Japan
              45586 Nephron 2000;84:258–266
              © 2000 S. Karger AG, Basel

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              Figures: 3, Tables: 2, References: 54, Pages: 9
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