Syndrome of rapid-onset end-stage renal disease in two consecutive renal transplant recipients
Patient I is a 53-year-old Caucasian type 1 diabetic woman with simultaneous pancreas-kidney transplantation (SPK) in 2000 for ESRD and was maintained on chronic transplant immunosuppression with tacrolimus, cellcept, and prednisone. Through most of 2010, her allograft CKD stage III had remained stable; serum creatinine was 1.6 mg/dL dl on November 23, 2010. In January 2011, she experienced transplant pyelonephritis precipitating AKI, further complicated by dehydration from 1one week of nausea, vomiting, and diarrhea. The patient’s serum creatinine rose quickly within days to 5.16 mg/dLdl. [] depicts the eGFR trajectory over time. Concurrently, she developed progressive oliguria, anorexia, and volume overload, requiring emergent hemodialaysis via a tunneled central dialysis catheter on January 8, 2011. Kidney allograft biopsy carried out the following week at Mayo Clinic, Rochester, following a referral, revealed acute tubular necrosis (ATN) and chronic transplant glomerulopathy without rejection, even though she received empiric high-dose, short-course tapered steroid therapy for possible rejection. She remained on maintenance hemodialysis for oliguric irreversible ESRD until January 2012, a year later, when she was successfully re-transplanted with a living-related kidney allograft from her 32-year year-old son, again at Mayo Clinic, Rochester. It is noteworthy that her pancreas allograft has, however, remained functional throughout this period with a current normal hemoglobin A1c (HbA1c) of 5.5% as at May 2012.