A rare cause of proteinuria after kidney transplantation: Questions

Excerpt

A 12-year-old male kidney transplant recipient was referred to our clinic with deterioration of kidney function and proteinuria. His medical history revealed that at the age of 5 years he presented with macroscopic hematuria, edema, hypertension, oliguria, high serum creatinine level (3.9 mg/dL), and significant proteinuria. Serum levels of complement C3 (110 mg/dL) and C4 (32 mg/dL) were within normal limits. Antinuclear antibody, anti-neutrophil cytoplasmic antibodies, and antibodies against glomerular basement membrane (GBM) were negative. Kidney biopsy showed 12 glomeruli with global sclerosis in six and fibrocellular crescents in four. Other changes included glomerular hypercellularity, endocapillary proliferation, and thickening and duplication of the GBM. Immunofluorescence staining showed IgG (3+), IgA (1+), IgM (2+), and C3 (3+) positivity in the mesangium and along the GBM. Biopsy material was not enough for electron microscopy because of the high level of glomerulosclerosis. He was diagnosed with membranoproliferative glomerulonephritis with crescents and global sclerosis. He did not respond to steroids, cyclophosphamide, and plasmapheresis therapy, and started peritoneal dialysis 1 month after the onset of the disease. …