Looking beyond the obvious: IgA nephropathy in a liver transplant recipient

Seventeen years after a liver transplant for biliary atresia, an adolescent presented with renal failure. The serum level of cyclosporine was sub-therapeutic; and, in spite of dosage adjustments, the patient's status did not improve. Given the patient's age, future renal transplant was a feasible consideration. However, this warranted investigation in the form of a renal biopsy in an attempt to confirm the underlying cause(s) of her renal failure. The renal biopsy revealed marked alteration in the renal anatomy due to IgA deposition, interstitial fibrosis, and hyaline arteriopathy.