Post-reperfusion rapidly progressive glomerulonephritis in post-transplant lgA nephropathy

David Tovbin, Alla Shnaider, Leonid Kachko, Anna Basok, Marina Vorobiov, Boris Rogachev, Dan Abramov, Moshe Zlotnik

Research output: Contribution to journalArticlepeer-review

3 Scopus citations

Abstract

Rapidly progressive glomerulonephritis (RPGN) is a rare occurrence in IgA nephropathy (IgAN) in renal transplant patients on immunosuppressive therapy. RPGN post ischemia-reperfusion has not been previously reported. We report a 62- year-old male patient on azathioprine therapy, 9 years after left cadaveric renal transplantation due to end stage renal disease of unknown etiology, who presented with progressive deterioration in renal function and hematuria. Renal biopsy was consistent with IgAN. Duplex and CT scan demonstrated a decreased renal graft perfusion, due to severe atherosclerosis and stenosis of iliac arteries. The patient underwent left axilo-femoral bypass graft surgery with improvement in kidney graft perfusion and function. However, few weeks later, patient presented with pulmonary edema and advanced renal failure and he was initiated on hemodialysis. Repeated renal biopsy demonstrated crescentic GN. To the best of our knowledge, this is the first report of RPGN following reversal of ischemia and reperfusion. There was no evidence for atherembolic disease which is not uncommon after vascular surgery and it has been reported to be rarely associated to crescentic GN. Theoretical explanations for exacerbation of IgAN to crescentic GN, following successful reperfusion, could be enhancement of capillary damage, inflammation and oxidative stress. Putative mechanisms for these phenomena may be interaction of reperfusion-induced hyperfiltration, high intraglomerular capillary pressure, oxidative stress, increased polymorphonucler cells infiltration and inflammation; the presence of IgA immune deposits and azathioprine metabolites, both can also be associated to enhancement of oxidative stress.

Original languageEnglish
Pages (from-to)130-133
Number of pages4
JournalJournal of Nephrology
Volume17
Issue number1
StatePublished - 1 Jan 2004
Externally publishedYes

Keywords

  • Crescentic glomerulonephritis
  • IgA nephropathy
  • Ischemia
  • Oxidative stress
  • Rapidly progressive glomerulonephritis
  • Reactive oxygen species
  • Reperfusion

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