Encephalopathy in a kidney transplant recipient.

Area of Science:

• Nephrology
• Neurology

Background:

• A 60-year-old kidney transplant recipient on hemodialysis presented with confusion and behavioral changes.
• The patient had presumed chronic nephropathy of the transplanted kidney and was not on immunosuppressive therapy.

Observation:

• Elevated C-reactive protein, proteinuria, leukocyturia, and erythrocyturia suggested nephritic syndrome consistent with transplant nephropathy.
• Neurologic deterioration persisted despite unremarkable brain CT and cerebrospinal fluid examination.
• Infection, autoimmune disease, and malignancy were ruled out.

Findings:

• Corticoid therapy initiated for suspected rejection nephropathy resulted in dramatic clinical improvement.
• Histological confirmation of chronic nephropathy of the transplanted kidney was obtained after kidney removal.
• The patient became asymptomatic without corticoid therapy post-nephrectomy.

Implications:

• This case highlights the potential for neurologic symptoms in chronic transplant nephropathy.
• Prompt diagnosis and management, including consideration of nephrectomy, can lead to favorable outcomes.
• The interplay between renal function and neurological status in transplant patients warrants further investigation.