Rapamycin-associated post-transplantation glomerulonephritis and its remission after reintroduction of calcineurin-inhibitor therapy |
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Authors: | Elisabeth Dittrich Sabine Schmaldienst Afschin Soleiman Walter H Hrl Erich Pohanka |
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Institution: | (1) Department of Medicine III, Division of Nephrology and Dialysis, University of Vienna, 1090 Vienna, Austria;(2) Department of Pathology, University of Vienna, Vienna, Austria |
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Abstract: | Rapamycin is a new immunosuppressive agent approved for maintenance therapy after kidney transplantation. It may allow calcineurin-inhibitor-free, non-nephrotoxic immunosuppression. We report, however, on four kidney-transplant recipients who developed post-transplantation glomerulonephritis after conversion from a calcineurin-inhibitor-based immunosuppression to rapamycin. In all four patients nephrotic-range proteinuria occurred 2–9 months after conversion to rapamycin. Renal biopsy confirmed membrano-proliferative glomerulonephritis type 1 in one case, membranous glomerulonephritis in another and IgA-nephropathy in two cases, respectively. Calcineurin-inhibitor-based immunosuppression was reintroduced and resulted in complete remission of proteinuria and in stabilised renal function in all patients. We conclude that in the case of rapamycin-associated post-transplantation glomerulonephritis an attempt should be made to replace rapamycin by a calcineurin inhibitor. |
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Keywords: | Calcineurin inhibitor Glomerulonephritis Rapamycin Renal transplantation |
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