RESUMEN
Successful kidney transplant corrects mineral and bone disorderto a large extent; however, disorders can persistin up to 80% ofrecipients.We describe a case of persistent hyperparathyroidism with graft dysfunction and metastatic calcification in graft biopsy. A 48-yearold renal transplant recipient developed graft dysfunction 3 weeks after kidney transplant. During pretransplant workup, the recipient was found to have severe secondary hyperparathyroidism (intact parathyroid hormone level of 2000 pg/mL), which was managed and well controlled before transplant. Graft dysfunction was evaluated using algorithmic approach. Prerenal causes, tacrolimus toxicity, and infections were ruled out. Graft biopsy revealed several foci of tubular and parenchyma calcific deposits (microcalcinosis) with tubular injury. The patient was restarted on medical management of hyperparathyroidism, and he showed improvement over 6 weeks, along with creatinine level returning to nadir value. Vascular and graft calcification is an independent predictor of long-term graftfunction and overall mortality. This report describes the challenges that we faced in diagnosis and management of persistent hyperparathyroidism, as no randomized controlled trials and guidelines are available.
Asunto(s)
Calcinosis , Hiperparatiroidismo Secundario , Trasplante de Riñón , Humanos , Trasplante de Riñón/efectos adversos , Hiperparatiroidismo Secundario/etiología , Hiperparatiroidismo Secundario/diagnóstico , Masculino , Persona de Mediana Edad , Resultado del Tratamiento , Biopsia , Calcinosis/etiología , Calcinosis/cirugía , Calcinosis/diagnóstico , Aloinjertos , Inmunosupresores/efectos adversos , Inmunosupresores/uso terapéutico , Biomarcadores/sangre , Factores de Tiempo , Enfermedades Renales/etiología , Enfermedades Renales/diagnóstico , Hormona ParatiroideaRESUMEN
Parasitic infections like filariasis are uncommon causes of secondary membranous nephropathy (MN) which requires serological tests to detect circulating Wuchereria bancrofti antigens for its diagnosis or the identification of microfilariae in the capillary lumen on kidney biopsy. The immunochromatographic card tests is simple, non invasive and has high sensitivity and specificity. We report a case of 30 year old lady who presented to us with nephrotic syndrome which on kidney biopsy showed features of membranous nephropathy with negative staining for Anti PLA2R, THSD7A and exostosin. A thorough workup was done to find out any secondary cause of MN where she was found positive with filiarial antibody test. Hence, a diagnosis of secondary membranous pattern nephropathy was considered for which she was treated with diethylcarbamazine (DEC) and other supportive medications which on follow up showed marked resolution of proteinuria.