Department of Nephro-Urology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan.
Clin Transplant. 2012 Jul;26 Suppl 24:81-5. doi: 10.1111/j.1399-0012.2012.01645.x.
We report the clinical and pathological findings of a case of de novo minimal change disease (MCD) after ABO-incompatible living kidney transplantation. A 62-yr-old man with end-stage renal disease associated with type I diabetes received ABO-incompatible kidney transplantation from his 58-yr-old wife. Although allograft function was excellent immediately after surgery, massive proteinuria (35 g/d) appeared on post-transplantation day 5. After the allograft biopsy taken on post-transplantation day 6, he was treated with 12 cycles of plasma exchange, but the nephrotic-range proteinuria showed no remission. The biopsy specimen showed no significant pathological findings on light microscopy, but electron microscopy showed diffuse effacement of podocyte foot processes. Based on the diagnosis of de novo MCD, the patient received intravenous methylprednisolone pulse therapy, followed by high-dose steroid maintenance therapy. The steroid therapy induced complete remission of nephrotic syndrome and stable allograft function immediately, which was also maintained at one yr after the transplantation.
我们报告了一例 ABO 不相容活体肾移植后新发微小病变病（MCD）的临床和病理发现。一名 62 岁的男性患有 I 型糖尿病相关的终末期肾病，接受了其 58 岁妻子的 ABO 不相容肾脏移植。尽管手术后移植物功能立即良好，但在移植后第 5 天出现大量蛋白尿（35 g/d）。在移植后第 6 天进行了移植物活检后，他接受了 12 个周期的血浆置换治疗，但肾病范围的蛋白尿没有缓解。光镜下活检标本无明显病理发现，但电镜显示足细胞足突弥漫性消失。基于新发 MCD 的诊断，患者接受了静脉注射甲基泼尼松龙脉冲治疗，随后进行了大剂量类固醇维持治疗。类固醇治疗立即诱导肾病综合征完全缓解和移植物功能稳定，移植后 1 年也得到了维持。
