[Show abstract][Hide abstract] ABSTRACT: We report clinical and histopathologic findings of a case of acute rejection with adenovirus infection after kidney transplantation. A 63-yr-old woman with end-stage renal disease caused by lupus nephritis received an ABO-incompatible living kidney transplantation from her husband. On the 7th post-operative day (POD), she had fever, hematuria, and bladder irritation. Although she was treated with an antibiotic, the symptoms were not improved. We diagnosed adenovirus infection as positive with the urine shell vial method and blood PCR analysis. Cyclophosphamide was interrupted and immunoglobulin therapy was performed. However, urine output decreased and serum creatinine levels increased. An episode biopsy was performed on POD 20. We diagnosed acute antibody-mediated rejection. She was treated with plasma exchange for acute rejection and antiviral drug (rivabirin) for active adenovirus infection. However, the renal graft dysfunction was deemed irreversible and the renal graft was removed on POD 34. The graftectomy specimen showed acute rejection and acute tubular necrosis with adenovirus infection.
[Show abstract][Hide abstract] ABSTRACT: Live kidney donors are supposed to have no clinical kidney disease. Here, we present a unique case of subclinical membranous nephropathy (MN) from a living donor, who had urinalysis-free stable kidney function pre- and post-transplant. A 39-yr-old Asian woman received a second kidney graft from her spouse whose urinalysis and blood chemistry were stable and normal. Her intraoperative one-h core biopsy revealed thick glomerular basement membrane (GBM) and a bubbly type appearance, compatible with stage II MN on Churg’s classification. According to two other protocol biopsies, GBM thickening persisted until month six post-transplant. Interestingly, both the donor and the recipient had stable kidney function without overt proteinuria at each monthly visit until one yr post-transplant. Taken together, we speculate that “silent” MN may exist in certain healthy individuals, who present only with histopathologically compatible MN and no other findings.