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Kidney transplantation for a patient with refractory childhood-onset ANCA-associated vasculitis.

Authors :
Kaseda K
Marui Y
Suwabe T
Hoshino J
Sumida K
Hayami N
Mise K
Tanaka K
Takaichi K
Tomikawa S
Fujii T
Ohashi K
Ubara Y
Source :
Modern rheumatology [Mod Rheumatol] 2016; Vol. 26 (2), pp. 307-9. Date of Electronic Publication: 2014 Mar 19.
Publication Year :
2016

Abstract

A 14-year-old Japanese girl was admitted to our institution for the evaluation of renal dysfunction. Her serum creatinine was 1.1 mg/dL, proteinuria was 1.5 g/day, the urine sediment contained numerous erythrocytes per high-power field, and she was positive for myeloperoxidase anti-neutrophil cytoplasmic antibody (MPO-ANCA). Proteinuria was first noted at the age of 12 years. Renal biopsy showed crescentic glomerulonephritis with slight immunoglobulin A (IgA) deposition. A diagnosis of ANCA-associated vasculitis was made. Immunosuppressive therapy was initiated, including steroid pulse therapy and intravenous cyclophosphamide pulse therapy, but hemodialysis was required after 6 years. Eight months after the patient became anuric and her MPO-ANCA titer became negative, living-related donor kidney transplantation was done from her mother. ANCA became slightly positive 2 years later, but the patient remains stable without proteinuria or hematuria at 4 years after surgery. This case suggests that kidney transplantation can be performed successfully for a patient with refractory childhood-onset ANCA-associated vasculitis, and that remission of vasculitis associated with ANCA negativity at transplantation may contribute to a better renal prognosis in this patient.

Details

Language :
English
ISSN :
1439-7609
Volume :
26
Issue :
2
Database :
MEDLINE
Journal :
Modern rheumatology
Publication Type :
Academic Journal
Accession number :
24645722
Full Text :
https://doi.org/10.3109/14397595.2013.877327