Spontaneous improvement of renal function following renal allograft rupture associated with acute rejection

A renal allograft recipient developed acute cellular rejection 7 days after her second cadaveric renal transplantation. Her renal function failed to improve after three 0.5 g pulses of intravenous Methylprednisolone therapy. Spontaneous renal allograft rupture occurred 4 days later, which was successfully salvaged surgically. There was spontaneous rapid improvement of renal function with marked diuresis immediately following the allograft rupture, without additional immunosuppressive therapy. Her clinical course illustrates that delayed improvement of renal allograft function can be a consequence of raised intra-renal pressure during acute rejection. In addition, intensification of anti-rejection therapy is not an absolute requirement in all cases of rejection-associated renal allograft rupture.