Elsevier

Transplantation Proceedings

Volume 41, Issue 9, November 2009, Pages 3953-3955
Transplantation Proceedings

Case report
Renal
A Case of Recurrent Immunotactoid Glomerulopathy in an Allograft Treated With Rituximab

https://doi.org/10.1016/j.transproceed.2009.03.100Get rights and content

Abstract

Immunotactoid glomerulopathy is a glomerular disorder typified by hollow cylindrical and sometimes spherical microtubular deposits, with a diameter of 30–40 nm, but up to 90 nm, often in a parallel arrangement or in intersecting bundles. These patients frequently end up receiving kidney transplants due to progressive renal insufficiency. Known to recur in renal transplant recipients with variable outcomes, its treatment options are limited. Classically steroids, cyclophosphamide, mycophenolate mofetil, and plasma exchanges have been used to treat these recurrences. More recently, rituximab has been suggested as a treatment and has demonstrated improved outcomes in other glomerular diseases. Herein we describe a case of a middle-aged female renal transplant recipient for end-stage renal disease secondary to immunotactoid glomerulopathy, who experienced a recurrence of this condition in the transplanted kidney. Following a failure of conventional therapy we administered a course of rituximab, resulting in a reduction and stabilization of her serum creatinine level while her proteinuria persisted.

Section snippets

Case Report

A 56-year-old female with end-stage renal disease secondary to ITG received a cadaveric kidney transplant. She had a past medical history of fibromyalgia, osteoarthritis, asthma, gastroesophageal reflux disease (GERD), hypertension, and monoclonal gammopathy of undetermined significance (MGUS). Postoperatively she was placed on a triple regimen of tacrolimus, mycophenolate mofetil (MMF), and prednisone. Seven weeks after transplantation her serum creatinine level increased to 1.3 mg/dL from a

Discussion

Patients with ITG generally present with proteinuria, usually marked, and associated nephrotic syndrome and hematuria.2 The mean age of these patients is in their sixties.3 There is a relationship with lymphoproliferative disorders in patients who exhibit this type of renal disease.4 By light microscopy, mesangial or diffuse proliferative patterns are the most commonly recognized. Congo red stain is always negative. By immunofluorescence, coarse deposits of IgG and C3, either mesangial or

References (15)

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