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Case Study: Renal Transplant Complications in a Patient with IgA Nephropathy

A detailed case study of a 34-year-old male with IgA nephropathy who underwent renal transplant in 1999. Currently presenting with increased serum creatinine levels, the case explores potential complications, including antibody-mediated rejection and calcineurin inhibitor toxicity. Diagnostic findings and treatment options are discussed.

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Case Study: Renal Transplant Complications in a Patient with IgA Nephropathy

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  1. U07-2732 #326035820 • Renal Tx 1999 • Previous IgA nephropathy • Increased serum creatinine

  2. 34 years old • S/P DD renal transplant Jun 1999 - ESRD secondary to GN (mesangioproliferative immune complex GN), IgA negative - HTN - Dyslipidemia

  3. Base line Cr 105-115 • Medications: • Cellcept, prednisone, Tacrolimus • Norvasc • Atorvastatin • Jan 25/2007 Cr increased to 142 (Tacrolimus level 3.2) • Urine analysis: negative for protein, Hb • Normal U/S, renal scan mild functional impairment

  4. IF • IgG-Negative. • IgA- Moderate mesangial staining. • IgM-Negative. • C3-Negative. • C1q-Negative. • Kappa- Mild mesangial staining. • Lambda-Negative. • Fibrinogen- Mild to moderate interstitial staining. • Albumin-Negative.

  5. IgA

  6. Kappa

  7. Fibrin

  8. IF • C4d-Focal linear peritubular capillary staining with a positive control showing uneven positivity. • Repeated C4d- Negative with a negative positive control. • Second repeat C4d- Focal (less than 50%) linear peritubular capillary staining.

  9. C4d

  10. EM • Is pending

  11. DiagnosisRenal Biopsy: • De novo or recurrent IgA nephropathy with focal mesangioproliferative GN. • Possible antibody-mediated rejection (equivocal C4d positivity, to correlate with clinical findings). • Hyaline arteriolar changes suggesting calcineurin inhibitor toxicity. • Specimen of marginal adequacy. • Banff score: • G1 CG0 I0 CI1 T1 CT0 V0 CV2 AH2 MM2

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