Hussain Zoya, Chhabra Darshika
Advocate Christ Medical Center, Kidney Transplant, Oak Lawn, Illinois, USA.
Advocate Christ Medical Center, Kidney Transplant, Oak Lawn, Illinois, USA.
Transplant Proc. 2019 Nov;51(9):3099-3102. doi: 10.1016/j.transproceed.2019.04.031. Epub 2019 Jul 26.
We present a case of de novo minimal change disease occurring more than 1 year after transplant in a combined heart-kidney transplant recipient. A 68-year-old white man with past medical history of nonischemic cardiomyopathy with left-ventricular assist device and end-stage renal disease due to type 2 diabetes mellitus and cardiorenal syndrome underwent a combined heart-kidney transplant in a sequential manner in August 2016. He was induced with rabbit antithymocyte globulin and methylprednisolone; he was maintained on mycophenolate mofetil, tacrolimus, and a protocolized tapering dose of prednisone. More than 1 year after transplant, in December 2017, he had about 2.3 g of proteinuria. Kidney function remained stable with a creatinine of 1.2 mg/dL. Serologic and infectious workup was nonrevealing. Proteinuria peaked at 4.5 g in January 2018, and kidney biopsy results were consistent with minimal change disease. After the biopsy, his prednisone dosage was escalated to 80.0 mg daily and slowly tapered to 2.5 mg (including most recent follow-up data from May 2019) daily, in alignment with improvement in his proteinuria and creatinine. Proteinuria decreased to 130.0 mg/g. To our knowledge, this is the first reported case of its kind in a combined heart-kidney transplant patient.
我们报告了一例心脏-肾脏联合移植受者在移植1年多后新发微小病变病的病例。一名68岁白人男性，既往有非缺血性心肌病病史并植入左心室辅助装置，因2型糖尿病和心肾综合征导致终末期肾病，于2016年8月先后接受了心脏-肾脏联合移植。他接受了兔抗胸腺细胞球蛋白和甲泼尼龙诱导治疗；维持使用霉酚酸酯、他克莫司，并按方案逐渐减少泼尼松剂量。移植1年多后，即2017年12月，他出现了约2.3 g蛋白尿。肾功能保持稳定，肌酐为1.2 mg/dL。血清学和感染方面的检查未发现异常。2018年1月蛋白尿峰值达到4.5 g，肾脏活检结果符合微小病变病。活检后，他的泼尼松剂量增加至每日80.0 mg，并缓慢减至每日2.5 mg（包括2019年5月的最新随访数据），同时蛋白尿和肌酐有所改善。蛋白尿降至130.0 mg/g。据我们所知，这是心脏-肾脏联合移植患者中首例此类报告病例。
