Dose Kidney Transplant Nephrectomy Stop Disease Progression in Plasma Exchange Resistant Post Transplant Hemolytic Uremic Syndrome? A Case Report

Overview

Journal J Nephropathol

Specialty Nephrology

Date 2014 Jan 30

PMID 24475432

Authors

Farzaneh Sharifipour

Abbasali Zeraati

Seyed Seifollah Beladi Mousavi

Fatemeh Hayati

Mohsen Tavazoe

Marzieh Beladi Mousavi

Affiliations

Soon will be listed here.

Abstract

Background: Two different case reports, which have been published previously, suggested that bilateral nephrectomy can improve sever and refractory hemolytic uremic syndrome (HUS) in adults without a history of transplantation. At this study, kidney transplant nephrectomy in a patient with sever post transplant HUS was investigated.

Case: Patient was a 55 years old man with a single small size kidney and end-stage renal disease (ESRD). He had received a kidney from an unrelated donor three months before admission. The patient was admitted with fever and acute renal failure. Clinical and laboratory evaluation wereconsistent with sever De novo hemolytic uremic syndrome (HUS). Different therapeutic regimens administered in this patient including intensive plasma exchange, plasma infusion, empirical antibiotics, and high doses of corticosteroid. Although Cyclosporine was changed to Tacrolimus. After 45 days of treatment, patient's condition did not improve and sever thrombocytopenia (10000-15000/µL) developed. Patient was also suffered from severe hypersensitivity reaction (fever, chills, and itching) following each plasma exchange. Kidney transplant nephrectomy was done. However, sever post operativebleedingoccurred.HUS and thrombocytopenia did not improve and patient died two days after operation.

Conclusions: According to this experience, Kidney transplant nephrectomy may not be an effective treatment and is not recommended in the treatment of severe and refractory post transplant HUS.

References

George J . Clinical practice. Thrombotic thrombocytopenic purpura. N Engl J Med. 2006; 354(18):1927-35. DOI: 10.1056/NEJMcp053024. View

Caramazza D, Quintini G, Abbene I, Malato A, Saccullo G, Lo Coco L . Relapsing or refractory idiopathic thrombotic thrombocytopenic purpura-hemolytic uremic syndrome: the role of rituximab. Transfusion. 2010; 50(12):2753-60. DOI: 10.1111/j.1537-2995.2010.02763.x. View

Waiser J, Budde K, Rudolph B, Ortner M, Neumayer H . De novo hemolytic uremic syndrome postrenal transplant after cytomegalovirus infection. Am J Kidney Dis. 1999; 34(3):556-9. DOI: 10.1016/s0272-6386(99)70085-5. View

Ruggenenti P . Post-transplant hemolytic-uremic syndrome. Kidney Int. 2002; 62(3):1093-104. DOI: 10.1046/j.1523-1755.2002.00543.x. View

Artz M, Steenbergen E, Hoitsma A, Monnens L, Wetzels J . Renal transplantation in patients with hemolytic uremic syndrome: high rate of recurrence and increased incidence of acute rejections. Transplantation. 2003; 76(5):821-6. DOI: 10.1097/01.TP.0000085083.74065.1B. View

von Baeyer H . Plasmapheresis in thrombotic microangiopathy-associated syndromes: review of outcome data derived from clinical trials and open studies. Ther Apher. 2002; 6(4):320-8. DOI: 10.1046/j.1526-0968.2002.00390.x. View

Michael M, Elliott E, Ridley G, Hodson E, Craig J . Interventions for haemolytic uraemic syndrome and thrombotic thrombocytopenic purpura. Cochrane Database Syst Rev. 2009; (1):CD003595. PMC: 7154575. DOI: 10.1002/14651858.CD003595.pub2. View

Kiykim A, Ozer C, Yildiz A, Tiftik N, Senli M, Kelebek E . Development of transplant renal artery thrombosis and signs of haemolytic-uraemic syndrome following the change from cyclosporin to tacrolimus in a renal transplant patient. Nephrol Dial Transplant. 2004; 19(10):2653-6. DOI: 10.1093/ndt/gfh375. View

Ruggenenti P, Noris M, Remuzzi G . Thrombotic microangiopathy, hemolytic uremic syndrome, and thrombotic thrombocytopenic purpura. Kidney Int. 2001; 60(3):831-46. DOI: 10.1046/j.1523-1755.2001.060003831.x. View

10.

Allford S, Hunt B, Rose P, Machin S . Guidelines on the diagnosis and management of the thrombotic microangiopathic haemolytic anaemias. Br J Haematol. 2003; 120(4):556-73. DOI: 10.1046/j.1365-2141.2003.04049.x. View

11.

George J, Woodson R, Kiss J, Kojouri K, Vesely S . Rituximab therapy for thrombotic thrombocytopenic purpura: a proposed study of the Transfusion Medicine/Hemostasis Clinical Trials Network with a systematic review of rituximab therapy for immune-mediated disorders. J Clin Apher. 2006; 21(1):49-56. DOI: 10.1002/jca.20091. View

12.

Schwimmer J, Nadasdy T, Spitalnik P, Kaplan K, Zand M . De novo thrombotic microangiopathy in renal transplant recipients: a comparison of hemolytic uremic syndrome with localized renal thrombotic microangiopathy. Am J Kidney Dis. 2003; 41(2):471-9. DOI: 10.1053/ajkd.2003.50058. View

13.

Bell W, Braine H, Ness P, Kickler T . Improved survival in thrombotic thrombocytopenic purpura-hemolytic uremic syndrome. Clinical experience in 108 patients. N Engl J Med. 1991; 325(6):398-403. DOI: 10.1056/NEJM199108083250605. View

14.

Abramowicz D, Pradier O, Marchant A, Florquin S, De Pauw L, Vereerstraeten P . Induction of thromboses within renal grafts by high-dose prophylactic OKT3. Lancet. 1992; 339(8796):777-8. DOI: 10.1016/0140-6736(92)91897-h. View

15.

Jasti S, Coyle T, Gentile T, Rosales L, Poiesz B . Rituximab as an adjunct to plasma exchange in TTP: a report of 12 cases and review of literature. J Clin Apher. 2008; 23(5):151-6. DOI: 10.1002/jca.20172. View

16.

Remuzzi G, Galbusera M, Salvadori M, Rizzoni G, Paris S, Ruggenenti P . Bilateral nephrectomy stopped disease progression in plasma-resistant hemolytic uremic syndrome with neurological signs and coma. Kidney Int. 1996; 49(1):282-6. DOI: 10.1038/ki.1996.40. View

17.

Pham P, Peng A, WILKINSON A, Gritsch H, Lassman C, Pham P . Cyclosporine and tacrolimus-associated thrombotic microangiopathy. Am J Kidney Dis. 2000; 36(4):844-50. DOI: 10.1053/ajkd.2000.17690. View

18.

Ashman N, Chapagain A, Dobbie H, Raftery M, Sheaff M, Yaqoob M . Belatacept as maintenance immunosuppression for postrenal transplant de novo drug-induced thrombotic microangiopathy. Am J Transplant. 2009; 9(2):424-7. DOI: 10.1111/j.1600-6143.2008.02482.x. View

19.

Zarifian A, Odonovan R, Tesi R, Batuman V . Cyclosporine-associated thrombotic microangiopathy in renal allografts. Kidney Int. 1999; 55(6):2457-66. DOI: 10.1046/j.1523-1755.1999.00492.x. View

20.

Feldman M, Bruno T, Chong Y, Borstad G, Wild C, Lopez J . Bilateral nephrectomy for treatment resistant systemic lupus erythematosis and thrombotic thrombocytopenic purpura: a case report. Am J Hematol. 2006; 82(6):496-7. DOI: 10.1002/ajh.20842. View