Abstract: TH-PO769
A Case of Omeprazole-Associated Tubular Disease with Subsequent Kidney Transplant
Session Information
- Transplantation: Clinical - 1
October 24, 2024 | Location: Exhibit Hall, Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Transplantation
- 2102 Transplantation: Clinical
Authors
- Gitter, Christopher B., Medical College of Wisconsin, Milwaukee, Wisconsin, United States
- Rawashdeh, Badi, Medical College of Wisconsin, Milwaukee, Wisconsin, United States
- Gaddy, Anna R., Medical College of Wisconsin, Milwaukee, Wisconsin, United States
Introduction
Anti-tubular basement membrane (anti-TBM) antibody disease is an extremely rare disease characterized by the direct exposure of the renal tubular cell basement membrane, focused in the proximal tubule. Diagnosis is one of exclusion and treatment is generally similar to that of anti-glomerular basement membrane disease.Only one case of anti-TBM disease undergoing transplant has been reported.
Case Description
A 50 year old male presented to a tertiary care center for orthostatic hypotension and was found to have worsening of prior AKI. In the year prior to presentation, patient underwent extensive workup for esophageal dysmotility and was started on omeprazole three months prior to admission. One month prior to admission, patient presented to outside hospital for rash and AKI and was diagnosed with acute interstitial nephritis (AIN) with “unusual linear C3 deposition along basement membrane” attributed to omeprazole therapy. Physical exam showed diffuse macular rash and purpuric lesions on lips. Urinalysis demonstrated mild proteinuria, without hematuria or casts. Patient underwent native kidney biopsy which demonstrated extensive acute interstitial nephritis with linear IgG and C3 immunofluorescence staining of the tubular basement membranes. The patient underwent plasma exchange and was started on cyclophosphamide plus glucocorticoids. Clearance remained poor and the patient required maintenance dialysis. Due to polyuria, glucosuria, and orthostasis, the patient required high dose fludrocortisone and salt tablets and ultimately underwent bilateral renal artery glue embolization in an attempt to minimize wasting. Ultimately, the patient underwent uncomplicated deceased brain death kidney transplant, where graft biopsy was performed prior to anastomoses. Methylprednisone and anti-thymocyte were used for induction, with maintenance regimen of tacrolimus, mycophenylate mofetil, and prednisone started prior to discharge.
Discussion
Initial patient presentation remained consistent with AIN, however his continued polyuria likely was a result of extensive proximal tubular damage as demonstrated on biopsy. This case may represent the second case of successful kidney transplant in a patient with this disease presentation. Repeat graft biopsy as follow-up for kidney transplant may be beneficial in understanding further disease presentation and progression.