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Chronic Renal Failure Post Kidney Transplant: Diagnostic Progression Analysis

Case study of a LURD kidney transplant recipient after diabetes mellitus, tracking creatinine levels, CMV DNA load, and renal biopsy findings indicate possible early transplant glomerulopathy and viral infection. Treatment approach and immunostaining results discussed.

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Chronic Renal Failure Post Kidney Transplant: Diagnostic Progression Analysis

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  1. U06-8269 #902014120 DM.LURD tx Nov/05.Base creatinine 120 Progressive ↑creat 120-170 over 1 week. CMV ↑-no Rx yet

  2. U06-8269 Chronic renal failure due to diabetes mellitus LURD kidney transplant 1/11/05 with good initial function, creatinine 100-120. Immunosuppression: tacrolimous, Cellcept, prednisone, Donor CMV +ve; recipient CMV –ve. Valcyte started 900 mg daily until 15/02/06. Stunt removed 15/12/05 Creatinine 12 – 27/04/06: 122→142 →155 →170 CMV DNA viral load 6/04 3,90012/04 13,00020/04 6,00024/04 24,00027/04 57,000 (hemodialyzed)28/04 Biopsy

  3. IF • IgG-moderate linear GBM,mild linear TBM staining • IgA- mild to moderate GBM staining • IgM-trivial mesangial staining,minimal vascular staining • C3- mild vascular staining,trivial punctate mesangial staining • C1q-negative • Kappa-minimal linear GBM staining • Lambda- minimal linear GBM staining • Fibrin- mild punctate mesangial staining,focal mild interstitial staining • Albumin- moderate linear GBM and TBM staining,mild hyaline drop[let change in tubular cytoplasm • C4d-negative

  4. Diagnosis: Renal Biopsy:( six months post-transplantation): Minimal inflammation with focal multinucleated tubular epithelial cells suggestive viral infection. Immunostaining for CMV is negative. Rule out viral infection Probable early transplant glomerulopathy. No evidence of acute rejection.EM is pending. Banff scores: (G0 CG1 I1 CI1 T0 CT1 V0 CV0 AH0 MM0)

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