De novo normotensive scleroderma renal crisis six years after living-donor renal transplantation in a patient with overlapping systemic sclerosis/systemic lupus erythematosus syndrome: a case report

被引:1
作者
Sanada, Hajime [1 ]
Hara, Satoshi [1 ]
Horita, Makoto [1 ]
Kawahara, Hiroyuki [1 ]
Yoshida, Misaki [1 ]
Takahashi, Yoshinori [1 ]
Tsuge, Shunsuke [1 ]
Zoshima, Takeshi [1 ]
Nishioka, Ryo [1 ]
Ito, Kiyoaki [1 ]
Mizushima, Ichiro [1 ]
Matsushita, Takashi [2 ]
Kawano, Mitsuhiro [1 ]
机构
[1] Kanazawa Univ Hosp, Dept Rheumatol, 13-1 Takara Machi, Kanazawa, Ishikawa, Japan
[2] Kanazawa Univ, Grad Sch Med Sci, Dept Dermatol, Kanazawa, Japan
关键词
Scleroderma renal crisis; Systemic sclerosis; Kidney transplantation; THROMBOTIC MICROANGIOPATHY; KIDNEY-TRANSPLANTATION; ALLOGRAFT;
D O I
10.1186/s12882-023-03416-7
中图分类号
R5 [内科学]; R69 [泌尿科学(泌尿生殖系疾病)];
学科分类号
1002 ; 100201 ;
摘要
BackgroundScleroderma renal crisis (SRC) is a critical kidney involvement of systemic sclerosis (SSc), often resulting in end-stage renal disease. Although the recurrence of SRC in the allograft has been reported, the development of de novo SRC after kidney transplantation has not been reported. Furthermore, normotensive SRC, which rarely occurs, makes prompt diagnosis more challenging. This fact should be recognized widely among nephrologists.Case presentationWe report a 37-year-old Japanese man with overlapping SSc/systemic lupus erythematous syndrome who developed normotensive SRC in the transplanted kidney shortly after glucocorticoid escalation. Six years prior to admission, he underwent an ABO-compatible living donor kidney transplantation because of lupus nephritis. He was admitted to our hospital for gradually worsening kidney dysfunction. A kidney biopsy showed idiopathic granulomatous interstitial nephritis and high-dose prednisolone was prescribed. Although renal function improved tentatively, it deteriorated again a week later. A secondary kidney biopsy revealed acute thrombotic microangiopathy, leading to the diagnosis of normotensive SRC because all other causes were excluded, and blood pressure was within normal range. Adding an angiotensin-converting enzyme inhibitor and tapering glucocorticoid slowed the speed of deterioration of his kidney function, but he finally required hemodialysis induction.ConclusionsSRC can newly develop even in the transplanted kidney, especially when high-dose glucocorticoid is administered. Normotensive SRC makes the diagnosis challenging, so nephrologists should carefully monitor patients with SSc and transplanted kidneys to treat SRC promptly.
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相关论文
共 17 条
[1]   Kidney transplantation in patients with systemic sclerosis: a nationwide multicentre study [J].
Bertrand, Dominique ;
Dehay, Julien ;
Ott, Julien ;
Sberro, Rebecca ;
Brunelle, Charlotte ;
Kamar, Nassim ;
Colosio, Charlotte ;
Chatelet, Valerie ;
Albano, Laetitia ;
Girerd, Sophie ;
Audard, Vincent ;
Barbet, Christelle ;
Dantal, Jacques ;
Ducloux, Didier ;
Durrbach, Antoine ;
Garrigue, Valerie ;
Hazzan, Marc ;
Heng, Anne-Elisabeth ;
Mariat, Christophe ;
Merville, Pierre ;
Rerolle, Jean-Philippe ;
Moulin, Bruno ;
Guerrot, Dominique .
TRANSPLANT INTERNATIONAL, 2017, 30 (03) :256-265
[2]   Follow-up of kidney graft recipients with cyclosporine-associated hemolytic-uremic syndrome and thrombotic microangiopathy [J].
Bren, A ;
Pajek, J ;
Grego, K ;
Buturovic, J ;
Ponikvar, R ;
Lindic, J ;
Knap, B ;
Vizjak, A ;
Ferluga, D ;
Kandus, A .
TRANSPLANTATION PROCEEDINGS, 2005, 37 (04) :1889-1891
[3]   De novo Thrombotic Microangiopathy Induced by Cytomegalovirus Infection Leading to Renal Allograft Loss [J].
De Keyzer, Kristel ;
Van Laecke, Steven ;
Peeters, Patrick ;
Vanholder, Raymond .
AMERICAN JOURNAL OF NEPHROLOGY, 2010, 32 (05) :491-496
[4]   Systemic sclerosis [J].
Denton, Christopher P. ;
Khanna, Dinesh .
LANCET, 2017, 390 (10103) :1685-1699
[5]   De novo thrombotic microangiopathy after kidney transplantation [J].
Garg, Neetika ;
Rennke, Helmut G. ;
Pavlakis, Martha ;
Zandi-Nejad, Kambiz .
TRANSPLANTATION REVIEWS, 2018, 32 (01) :58-68
[6]   Kidney transplantation for systemic sclerosis improves survival and may modulate disease activity [J].
Gibney, EM ;
Parikh, CR ;
Jani, A ;
Fischer, MJ ;
Collier, D ;
Wiseman, AC .
AMERICAN JOURNAL OF TRANSPLANTATION, 2004, 4 (12) :2027-2031
[7]   NORMOTENSIVE RENAL-FAILURE IN SYSTEMIC-SCLEROSIS [J].
HELFRICH, DJ ;
BANNER, B ;
STEEN, VD ;
MEDSGER, TA .
ARTHRITIS AND RHEUMATISM, 1989, 32 (09) :1128-1134
[8]  
Iudici M, 2013, CLIN EXP RHEUMATOL, V31, pS157
[9]   Cytomegalovirus-induced thrombotic microangiopathy after renal transplant successfully treated with eculizumab: case report and review of the literature [J].
Java, Anuja ;
Edwards, Angelina ;
Rossi, Ana ;
Pandey, Richa ;
Gaut, Joseph ;
Delos Santos, Rowena ;
Miller, Brent ;
Klein, Christina ;
Brennan, Daniel .
TRANSPLANT INTERNATIONAL, 2015, 28 (09) :1121-1125
[10]   Late-Onset Scleroderma Renal Crisis Induced by Tacrolimus and Prednisolone: A Case Report [J].
Nunokawa, Takahiro ;
Akazawa, Masanobu ;
Yokogawa, Naoto ;
Shimada, Kota ;
Hiramatsu, Kazuko ;
Nishio, Yasuhide ;
Sugii, Shoji .
AMERICAN JOURNAL OF THERAPEUTICS, 2014, 21 (05) :E130-E133