Rapamycin-associated post-transplantation glomerulonephritis and its remission after reintroduction of calcineurin-inhibitor therapy.

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.

• Authors: Elisabeth Dittrich, Sabine Schmaldienst, Afschin Soleiman, Walter H Hörl, Erich Pohanka
• Journal: Transplant international : official journal of the European Society for Organ Transplantation (Transpl Int) Vol. 17 Issue 4 Pg. 215-20 (May 2004) ISSN: 0934-0874 [Print] Switzerland
• PMID: 15112032 (Publication Type: Case Reports, Journal Article)

Chemical References

• Calcineurin Inhibitors
• Immunosuppressive Agents
• Calcineurin
• Creatine
• Sirolimus

Topics

• Adult
• Calcineurin (therapeutic use)
• Calcineurin Inhibitors
• Creatine (blood)
• Female
• Glomerulonephritis (blood, chemically induced, pathology)
• Humans
• Immunosuppressive Agents (adverse effects)
• Kidney Transplantation
• Male
• Middle Aged
• Proteinuria (chemically induced)
• Sirolimus (adverse effects)
• Time Factors
• Treatment Outcome