Study: Megalocytic interstitial nephritis may trigger renal transplant rejection
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Key takeaways:
- The patient was a recent kidney transplant recipient with recurring infection.
- E. coli was consistently identified in all infections.
LONG BEACH, Calif. — Megalocytic interstitial nephritis may trigger issues with coexisting renal transplant rejection, and providers should focus on immunosuppressive regimen and infection control, according to presented data.
Munsef Barakat, MD, of the Medical University of South Carolina, and colleagues presented a case of megalocytic interstitial nephritis in a kidney transplant recipient with concurrent infection and rejection, at the National Kidney Foundation Spring Clinical Meetings, here.
A month post-transplant, the 50-year-old patient, who received the transplant from a deceased donor, had surgical course complications from recurrent peritransplant fluid collection and urosepsis, as well as abdominal infection and sepsis requiring drainage.
“The patient was a recent kidney transplant [recipient] with recurring infection and recent collection, which caused [him] to have suboptimal renal function,” Barakat told Healio.
The patient was re-hospitalized 7 months post-transplant after developing intra-abdominal and prostatic abscess that required transurethral resection.
Researchers performed a kidney biopsy, which showed tubulointerstitial inflammation, acute cellular rejection I-A and potential evidence of antibody-mediated rejection.
Considering the persistent infection, investigators started the patient on IV immunoglobulin instead of steroids. After the infection resolved, a repeat biopsy showed borderline rejection and megalocytic interstitial nephritis. Investigators reduced the patient’s mycophenolate mofetil dosage and adjusted the tacrolimus dosage.
“The challenge was we had to stop some of the immunosuppression, [which] we reduced gradually, according to Barakat. “The question that we had [was] how this was going to affect the patient in the long-term.”
On follow-up, the patient’s renal function remained stable, according to the findings.
E. coli was consistently identified in all infections, leading to the decision to discontinue megalocytic interstitial nephritis, the researchers said. The biopsy also showed signs of cellular rejection, posing a dilemma for the patient’s immunosuppression regimen. Researchers decided to restart a low-dose mycophenolate mofetil treatment.
“We followed [the patient] for 18 months. Kidney function appeared to be stable, and he responded well to the antibiotic course,” Barakat said. “The overall outcome at this point was good.”
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Barakat M, et al. Poster 489. Presented at: NKF Spring Clinical Meetings; May 14-18, 2024; Long Beach, Calif.
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