Acute phosphate nephropathy leading to graft failure

Excerpt

A 19-year-old hemodialysis patient with a medical history of hyperphosphatemia (3.25 mmol/L), hypercalcemia (2.65 mmol/L), and elevated serum intact parathyroid hormone level (1892.8 pg/mL) was admitted to our hospital for renal transplantation. The donor had died of a ruptured intracranial aneurysm. Time-zero biopsy of the graft revealed normal histological findings. However, serum creatinine did not decrease significantly and oliguria persisted after transplantation. Two weeks later, a lower abdominal computed tomography (CT) showed high-density images in the transplanted kidney, extending to the intra-abdominal area and subcutaneous area of right lower quadrant (Fig. 1). One month later, the patient underwent a graft biopsy. A large amount of crystal deposition was found in the renal tubules and von Kossa staining was positive; suggesting a diagnosis of acute phosphate nephropathy (Fig. 2). Furthermore, the genes of type II sodium-phosphate co-transporter (SLC34A1, SLC34A3) were detected in the donor, but no abnormalities were found. We speculate that the trigger for this case might be related to mineral and bone disorder of the recipient. Other risk factors such as immunosuppressive drugs and high-dose diuretics might exacerbate calcium phosphate deposition [1]. …