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Analyses of Proteinuria, Renal Infiltration of Leukocytes, and Renal Deposition of Proteins in Lupus-prone MRL/lpr Mice
Published on: June 8, 2022
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Recurrent proteinuria with graft dysfunction: a diagnostic and clinical conundrum
Abhilash Chandra1, Kiran Preet Malhotra2, Namrata S Rao1
1Department of Nephrology, Dr. Ram Manohar Lohia Institute of Medical Sciences, Lucknow, India.
Summary
This case study highlights a kidney transplant patient who developed antibody-mediated rejection due to donor-specific antibodies (DSA). Treatment with immunosuppressants and plasma exchange successfully reduced DSA and improved graft function.
Area of Science:
- Nephrology
- Immunology
- Transplantation
Background:
- Kidney transplantation is a life-saving treatment for end-stage renal disease.
- Maintaining long-term graft survival requires effective immunosuppression to prevent rejection.
- Early detection and management of rejection are crucial for graft preservation.
Observation:
- A kidney transplant recipient developed significant proteinuria and rising creatinine levels two years post-transplant.
- Allograft biopsy revealed features suggestive of antibody-mediated rejection, including glomerular basement membrane thickening and C4d deposition.
- Donor-specific antibodies (DSA) against HLA Class II were detected, despite negative PLA2R antibodies.
Findings:
- The patient was treated with a combination of pulse methylprednisolone, plasma exchange, intravenous immunoglobulin, and rituximab.
- This intensive immunosuppressive regimen led to a significant reduction in DSA levels.
- The treatment resulted in improved graft function, with decreased serum creatinine and proteinuria.
Implications:
- This case underscores the importance of DSA monitoring in kidney transplant recipients, even in the absence of PLA2R antibodies.
- Aggressive immunosuppressive therapy can be effective in managing antibody-mediated rejection.
- Successful management of rejection can lead to improved long-term kidney allograft survival.
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