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      Recurrent Lupus nephritis in the Second Allograft of a Patient with Systemic Lupus erythematosus

      a , b


      S. Karger AG

      Recurrent, Allograft, Lupus

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          Lupus glomerulonephritis is a common and serious complication of systemic lupus erythematosus (SLE) affecting up to 50% of lupus patients. Recurrent lupus nephritis is rare, complicating as low as 1% of the lupus transplant population according to some authors. However, it may be underreported with more realistic recurrent rates oscillating from 2.8 to 8.7%. We report the case of a patient with SLE who lost her first allograft 4 years after transplantation with a diagnosis of de novo fibrillary glomerulopathy. She underwent a second renal transplantation and her renal function was stable for the past 5 years. She now presented with skin rash, arthralgias and positive lupus serologies. Her creatinine was slightly elevated and proteinuria was also noted. A renal biopsy performed revealed a recurrent focal proliferative lupus nephritis (WHO III). Retrospectively, we believe that her first allograft was also lost to recurrent lupus nephritis. This is a unique case of recurrent lupus nephritis in the second allograft of a patient with SLE.

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          Most cited references 2

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          End-stage renal disease in lupus: Disease activity, dialysis, and the outcome of transplantation

           John Stone (1998)
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            De novo Fibrillary Glomerulopathy in the Renal Allograft of a Patient with Systemic Lupus erythematosus

            Lupus glomerulonephritis is a complication of systemic lupus erythematosus, with 10% of the patients developing end-stage renal disease. It is accepted that lupus patients are good candidates for kidney transplantation and that the disease activity is subdued after transplantation due to rigorous immunosuppression, with a low rate of graft loss due to recurrent glomerulonephritis. While recurrent fibrillary glomerulopathy has been reported in renal allografts, de novo disease has not. We report a patient with systemic lupus who underwent a renal transplantation and subsequently lost her allograft due to de novo fibrillary glomerulopathy. Four years after her first kidney transplant, the patient presented with acute deterioration of her renal function. A renal biopsy was performed, and it revealed a focal mesangioproliferative pattern with positive amorphous mesangial immunofluorescence staining for IgG and C3. Congo red staining was negative. Electron microscopy demonstrated the presence of randomly oriented nonamyloid fibrils in the mesangiun. The diagnosis of de novo fibrillary glomerulopathy was made. The patient lost her allograft and received a second cadaveric renal transplant 1 year later. She has had a stable renal function since then.

              Author and article information

              S. Karger AG
              October 2002
              18 October 2002
              : 92
              : 4
              : 947-949
              aAnatomical/Renal Pathology and bDivision of Nephrology and Hypertension, University of Utah Health Sciences Center and ARUP Laboratories, Salt Lake City, Utah, USA
              65458 Nephron 2002;92:947–949
              © 2002 S. Karger AG, Basel

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              Page count
              Figures: 2, References: 10, Pages: 3
              Self URI (application/pdf): https://www.karger.com/Article/Pdf/65458
              Short Communication

              Cardiovascular Medicine, Nephrology

              Lupus, Allograft, Recurrent


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