RESUMEN
Hemophagocytic syndrome (HPS) is a life-threatening hematological disorder in immunocompromised patients. Reactive HPS is observed in patients with systemic infection, neoplasia or auto-immune diseases. It is a rare hematological disorder after renal transplantation and must be suspected when fever and pancytopenia are seen in association with viral infections. HPS is usually associated with infection with the Cytomegalovirus and Epstein-Barr viruses. We report here a case of BK-virus-associated HPS.
Asunto(s)
Virus BK/efectos de los fármacos , Inmunosupresores/efectos adversos , Trasplante de Riñón/efectos adversos , Linfohistiocitosis Hemofagocítica/virología , Infecciones por Polyomavirus/virología , Infecciones Tumorales por Virus/virología , Adulto , Antivirales/uso terapéutico , Virus BK/inmunología , Virus BK/patogenicidad , Biopsia , Humanos , Huésped Inmunocomprometido , Linfohistiocitosis Hemofagocítica/inmunología , Linfohistiocitosis Hemofagocítica/terapia , Masculino , Infecciones por Polyomavirus/inmunología , Infecciones por Polyomavirus/terapia , Diálisis Renal , Factores de Riesgo , Factores de Tiempo , Resultado del Tratamiento , Infecciones Tumorales por Virus/inmunología , Infecciones Tumorales por Virus/terapiaRESUMEN
Renal oxalate deposition can be seen with primary hyperoxaluria, malabsorptive states, ethylene glycol toxicity and, rarely, with excessive vitamin C ingestion. We report a case of secondary hyperoxaluria in which the diagnosis was not considered initially because there was no past history of urinary calculi and no evidence of nephrocalcinosis on plain X-ray of the abdomen and ultrasonography. The disease was detected and diagnosed only after kidney transplantation. Secondary oxalosis can cause graft loss or delayed graft function. Biopsy of the allograft should be carefully examined for oxalate deposits even in the absence of a family history. When oxalosis is diagnosed, intensifying hemodialysis (HD) to eliminate calcium oxalate can help in the recovery of renal function in some cases. Systematic vitamin C supplementation in HD patients should be avoided as it can be a cause of secondary oxalosis.
Asunto(s)
Ácido Ascórbico/efectos adversos , Hiperoxaluria/inducido químicamente , Fallo Renal Crónico/terapia , Trasplante de Riñón , Riñón/efectos de los fármacos , Diálisis Renal , Adulto , Biopsia , Femenino , Humanos , Hiperoxaluria/diagnóstico , Hiperoxaluria/fisiopatología , Hiperoxaluria/terapia , Riñón/patología , Riñón/fisiopatología , Fallo Renal Crónico/fisiopatología , Fallo Renal Crónico/cirugía , Diálisis Renal/efectos adversos , Resultado del TratamientoRESUMEN
The incidence of Kaposi sarcoma (KS) has substantially increased among immunocompromised patients, suggesting a role for immunosuppressive drugs. The aim of this study was to evaluate the incidence, features, and outcome of KS among 307 kidney transplantation patients at our center between January 1994 and June 2010. During the study period, the 10 patients who developed KS (3.25%) showed a mean age at transplantation of 35.8 ± 8.7 years (range, 22 to 49 years). The mean interval between transplantation and occurrence of KS was 24.7 ± 21.36 months (range, 6 to 64 months). The mean time of antithymocyte globulin induction was 9.5 days (range, 6 to 13 days). KS was restricted to the skin in 7 cases, among which, one presented with associated Hodgkin lymphoma. Visceral involvement (one lung and one colon) was observed in two cases. One patient presented with a gastric KS without skin lesions. Immunosuppressive treatment was reduced, then withdrawn in three cases, resulting in regression of KS a few weeks later, but with graft loss requiring hemodialysis at 1, 3 and 4 months. Among the remaining 7 cases, we stopped mycophenalate mofetil (MMF) and switched from calcineurin inhibitors to sirolimus. Allograft function remained stable after the switch. Only one patient who already had allograft dysfunction due to biopsy-proven chronic allograft nephropathy. Deteriorated progressively, undergoing hemodialysis at 2 years after KS diagnosis. In conclusion, we observed a relatively high incidence of KS among our cases. The introduction of sirolimus resulted in complete regression of KS lesions with preserved graft function.
Asunto(s)
Neoplasias del Colon/inmunología , Inmunosupresores/uso terapéutico , Trasplante de Riñón/inmunología , Neoplasias Pulmonares/inmunología , Sarcoma de Kaposi/inmunología , Sirolimus/uso terapéutico , Neoplasias Cutáneas/inmunología , Neoplasias Gástricas/inmunología , Adulto , Inhibidores de la Calcineurina , Neoplasias del Colon/epidemiología , Sustitución de Medicamentos , Quimioterapia Combinada , Femenino , Rechazo de Injerto/inmunología , Rechazo de Injerto/prevención & control , Supervivencia de Injerto/efectos de los fármacos , Humanos , Inmunosupresores/efectos adversos , Incidencia , Trasplante de Riñón/efectos adversos , Neoplasias Pulmonares/epidemiología , Masculino , Persona de Mediana Edad , Diálisis Renal , Sarcoma de Kaposi/epidemiología , Neoplasias Cutáneas/epidemiología , Neoplasias Gástricas/epidemiología , Factores de Tiempo , Resultado del Tratamiento , Túnez/epidemiologíaRESUMEN
Brown tumor is a rare complication of secondary hyperparathyroidism. It is exceptionally encountered after kidney transplantation. We here report on a 54-year-old male recipient who developed a brown tumor localized in the right forearm, and whose initial presentation was atypical, mimicking a bone tumor. Hence, diagnosis of brown tumors should be suggested by clinicians in a context of hyperparathyroidism.
Asunto(s)
Neoplasias Óseas/diagnóstico , Hiperparatiroidismo Secundario/etiología , Trasplante de Riñón/efectos adversos , Nefritis Hereditaria/cirugía , Osteólisis/etiología , Diagnóstico Diferencial , Humanos , Masculino , Persona de Mediana Edad , Nefritis Hereditaria/complicaciones , Osteólisis/diagnóstico , Osteólisis/terapia , Valor Predictivo de las PruebasRESUMEN
De novo tumors are common complications after solid organ transplantation. Lymphoma and skin cancers are the most frequently observed malignancies. However, graft carcinomas can be observed to be five times more frequent after kidney transplantation compared to their incidence in the general population. We report a case of a 49-year-old female who developed an early adenocarcinoma of the graft as revealed by acute renal failure. She underwent transplantectomy and chemotherapy with hemodialysis therapy. Carcinoma of the graft is a rare but serious complication usually occurring late after transplantation. Close monitoring of a kidney recipient using abdominal ultrasound may detect this complication at early stages, which may improve the prognosis. Similarly, good screening of donors may prevent tumor transmission.
Asunto(s)
Adenocarcinoma/etiología , Neoplasias Renales/etiología , Trasplante de Riñón/efectos adversos , Adenocarcinoma/complicaciones , Femenino , Humanos , Fallo Renal Crónico/complicaciones , Fallo Renal Crónico/terapia , Neoplasias Renales/complicaciones , Persona de Mediana Edad , Complicaciones Posoperatorias , Diálisis Renal , Resultado del TratamientoRESUMEN
A retrospective study was conducted on 143 consecutive renal transplant recipients who had a functioning graft for three months or longer, to evaluate the prevalence of post-transplant erythrocytosis (PTE) and its potential risk factors. True PTE was defined as hematocrit (Ht) above 52% and hemoglobin (Hb) above 18 g/dl in males, and Ht above 50% and Hb above 17 g /dl in females. A total of 31 patients (21.6%) developed PTE; none had any evidence of polycythemia vera (PV), or secondary polycythemia due to reduced arterial oxygen, kidney or hepatic tumors, or relative erythrocytosis due to a decrease in plasma volume by overuse of diuretics. Thirty-one non-polycythemic patients (Hb 12.9 +-1.6 g/dl) matched for sex, age and renal function were used as case controls. PTE was more common in males (p= 0.043). The majority of our patients developed PTE within the first year post-transplantation and all had excellent renal function at the time of diagnosis. Also, PTE was found to be related to duration on dialysis prior to transplantation (p= 0.0013) and acute rejection (p= 0.0031).