Jan C I, Chen A, Sun G H, Yu D-S, Yen C-Y, Chen J S, Lin Y F
Department of Pathology, Tri-Service General Hospital, Cheng-Kung Road Sec, 2 No. 325, Taipei, Taiwan, R.O.C. 114.
Transplant Proc. 2003 Dec;35(8):2888-90. doi: 10.1016/j.transproceed.2003.10.056.
A young adult was diagnosed with steroid-resistant minimal change disease (MCD) without evidence of focal segmental glomerulosclerosis (FSGS) despite serial and detailed sectioning and screening of the renal biopsy. He received initial treatment with steroids and then cyclosporine plus low-dose steroids for 2 years. Renal function progressively deteriorated due to resistance to steroid and cyclosporine. Two months after initiation of hemodialysis, the patient received a living-related allogenic kidney transplant. However, recurrent nephrotic syndrome and renal insufficiency occurred after transplantation. In spite of aggressive treatment, renal function showed no significant improvement. The kidney graft was removed 2 weeks after transplantation. Serial sectioning and thorough sampling and screening revealed no evidence of FSGS, but light microscopy and electron microscopy showed the typical morphologic pattern of MCD, corresponding to the pretransplant diagnosis. We believe that this is the first reported case of recurrent MCD after renal transplant.
一名年轻成人被诊断为类固醇抵抗性微小病变病（MCD），尽管对肾活检进行了连续且详细的切片和筛查，但未发现局灶节段性肾小球硬化（FSGS）的证据。他最初接受了类固醇治疗，然后使用环孢素加小剂量类固醇治疗了2年。由于对类固醇和环孢素耐药，肾功能逐渐恶化。开始血液透析两个月后，患者接受了亲属活体同种异体肾移植。然而，移植后出现了复发性肾病综合征和肾功能不全。尽管进行了积极治疗，肾功能仍无明显改善。移植后2周，肾脏移植物被切除。连续切片以及全面的取样和筛查均未发现FSGS的证据，但光镜和电镜显示出MCD的典型形态学模式，与移植前诊断相符。我们认为这是首例肾移植后复发性MCD的报道病例。
