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- Title
De novo lupus-like glomerulonephritis after pediatric non-kidney organ transplantation.
- Authors
Farkas-Skiles, Cristina M.; Ettenger, Robert B.; Zuckerman, Jonathan E.; Pearl, Meghan; Venick, Robert S.; Weng, Patricia L.
- Abstract
Background: We propose a novel clinically significant finding, de novo lupus-like glomerulonephritis (DNLLGN), in patients with autoantibodies and kidney abnormalities in pediatric liver transplant (LT) and intestinal inclusive transplants (ITx). Methods: We describe the clinical, serologic, and histopathologic presentation and kidney outcomes in eight patients from our center found to have DNLLGN on kidney biopsy. Results: Pediatric recipients of non-kidney solid organ transplants developed an unusual de novo immune complex glomerulonephritis with morphologic similarity to lupus nephritis. Six had isolated LT (0.9% of all pediatric LT at our center) and two had ITx (2.1% of all ITx). Five (63%) presented with nephrotic syndrome. Five patients had autoantibodies. Patients underwent kidney biopsy at a mean of 11.5 years in LT and 2.8 years in ITx after the index transplant. Biopsies demonstrated changes similar to focal or diffuse active lupus. Follow-up eGFR at a mean of 6 years after biopsy showed a mean decrease of 30 ml/min/1.73 m2 in all patients (p = 0.11). Conclusions: DNLLGN has not been previously recognized in this clinical setting, yet 8 kidney biopsies from pediatric recipients of LT and ITx at our center in 25 years demonstrated this finding. DNLLGN appears to be an under-reported phenomenon of clinical significance.
- Subjects
INTESTINE transplantation; KIDNEY abnormalities; AUTOANTIBODIES; LUPUS nephritis; BIOPSY; LIVER transplantation; TRANSPLANTATION of organs, tissues, etc.; CHILDREN
- Publication
Pediatric Nephrology, 2022, Vol 37, Issue 1, p153
- ISSN
0931-041X
- Publication type
Article
- DOI
10.1007/s00467-021-05194-6