Recurrence of nephrotic syndrome in a patient after renal transplantation. Diagnostic difficulties

Abstract

Glomerulonephritis is a common cause of dialysis in Poland and refers to 0.1–0.7% of the population. An important clinical problem are glomerulopathies which appear in the transplanted kidney, because they may lead to graft loss. The aim of this study was to present a clinical case of a 42-year old patient with end-stage renal disease in the course of IgM nephropathy. The first symptoms appeared when he was 19. Despite treatment with immunosuppressive regimens in various schemes, he developed recurrent proteinuria and hypertension. The patient was repeatedly hospitalized with an exacerbation of the disease. Due to end-stage renal failure he has been treated with hemodialysis for 15 months. He received a kidney transplant from a cadaver donor. About 2 weeks after transplantation severe proteinuria was developed. Biopsy of transplant was performed. Histopathological report was inconclusive, but there were no obvious features of glomerulonephritis. 6 months after transplantation he developed nephrotic syndrome. Repeated biopsy was done. Histopathological examination of the transplanted kidney showed minimal change disease. The patient was given steroid pulses and obtained remission of nephrotic syndrome. Biopsy was complicated by the creation of an arteriovenous fistula. Due to the stabilization of hypertension the fistula was unclosed. The patient remains under the control of Transplantation Clinic. Now after more than a year after the recurrence of nephrotic syndrome, the daily proteinuria is stated below 1g and graft function is stable. Because of the recurrent nature of glomerulonephritis, and the possibility of the development of other transplant pathology to guide the optimal treatment it is sometimes necessary to perform a biopsy of the transplanted organ several times despite possible complications.