Kidney Week

Abstract: SA-PO889

Donor-Derived Proliferative Glomerulonephritis

Session Information

• Glomerular Diseases: Case Reports - 2
  October 26, 2024 | Location: Exhibit Hall, Convention Center
  Abstract Time: 10:00 AM - 12:00 PM

Category: Glomerular Diseases

• 1402 Glomerular Diseases: Clinical, Outcomes, and Therapeutics

Authors

• Haq, Kanza, Johns Hopkins University, Baltimore, Maryland, United States

Kanza Haq, MD

• Alasfar, Sami, Mayo Clinic Arizona, Phoenix, Arizona, United States

Sami Alasfar, MD, MPH, FASN

• Rosenberg, Avi Z., Johns Hopkins University, Baltimore, Maryland, United States

Avi Z. Rosenberg, MD, PhD

• Naqvi, Fizza F., Johns Hopkins University, Baltimore, Maryland, United States

Fizza F. Naqvi, MD

Introduction

Pre-existing glomerular disease in renal allografts is rarely reported in the literature. A majority of the cases are diagnosed retrospectively following transplant on reperfusion biopsy, or on discovery of the same lesion in both allografts from the donor.

Case Description

Two patients underwent deceased donor kidney transplant from a adult donor who had anoxic brain death in the setting of sepsis due to Streptococcus pneumoniae bacteremia. He was noted to have hematuria and proteinuria on pre-procurement urinalysis. 1st recepient was 50-year-old female with end-stage renal disease (ESRD) from diabetic nephropathy. She received Induction with thymoglobulin and methylprednisolone. Initial maintenance IS included tacrolimus, mycophenolate mofetil, and prednisone. The patient had delayed graft function (DGF). Urinalysis continued to demonstrate hematuria & proteinuria. Renal biopsy on POD 60 showed diffuse proliferative and exudative glomerulonephritis with focal cellular crescents (fig 1). Immunofluorescence was negative and no discrete electron dense immune deposits were seen. Follow-up biopsy 90 days post-transplant showed persistent exudative glomerulonephritis with severe tubulointerstitial scarring. Recipient serological work-up was negative. She remained on dialysis and has no evidence of renal recovery to date. Second recipient was a 52-year-old male with ESRD due to type 2 diabetes mellitus who also developed DGF. Post perfusion biopsy (Fig 2) showed similar diffuse proliferative and exudative glomerulonephritis. A follow-up biopsy 30 days post-transplant showed persistent glomerulonephritis with reduced neutrophilic inflammation and no signs of active immune-mediated rejection. EM was negative for deposits and IF remained negative. 2^nd recipient was able to come off dialysis and the creatinine slowly improved to a nadir of 2.5 mg/dL.

Discussion

Preexisting diseases in renal allografts can follow variable courses which often are disease and recipient dependent. This case highlights the importance of pre-engraftment biopsies as current clinical parameters used for donor selection are inadequate to assess pre-existing disease etiology and severity.