A 37-year-old woman with systemic lupus erythematosus and acute allograft failure

THE RENAL BIOPSY is considered the gold standard method for the diagnosis of the processes that cause graft dysfunction. Complete morphological studies must be systematically applied to these samples to specifically assess the etiology of those processes. The likelihood of a particular etiology largely depends on the interval since transplantation. In the early posttransplantation period, most cases of renal dysfunction are etiology by acute tubular necrosis, reperfusion injury, acute rejection, drug toxicity, obstruction, surgical complications, or infection. Later in the time course, other causes of graft dysfunction include chronic transplant nephropathy, cyclosporine toxicity, and recurrent or de novo glomerular diseases. However, recurrent disease also should be considered in some cases in the immediate posttransplantation period. We present a renal transplant recipient with systemic lupus erythematosus (SLE) and early allograft dysfunction and rapid graft failure. The serial biopsies and complete morphological studies permitted a specific diagnosis in this case.