Department of Nephrology, Brown University Warren Alpert Medical School, Providence, Rhode Island, USA
Brown Medicine, Division of Nephrology and Hypertension, Division of Renal Transplantation, Brown University Warren Alpert Medical School, Providence, Rhode Island, USA.
BMJ Case Rep. 2020 Oct 22;13(10):e237380. doi: 10.1136/bcr-2020-237380.
A 41-year-old man with end-stage renal disease received a deceased donor kidney transplant without complication. Maintenance immunosuppression consisted of tacrolimus, mycophenolate and prednisone. Two months after transplantation, his creatinine did not improve beyond 2-2.3 mg/dL, which prompted allograft biopsy. His biopsy showed tubular epithelial injury without rejection, and given concern for possible calcineurin-inhibitor toxicity, his tacrolimus was changed to sirolimus. Renal function improved, but 1 month later he presented to the hospital with seizure activity, severe hypertension, acute kidney injury and MRI findings suggestive of posterior reversible encephalopathy syndrome. Blood pressure was difficult to control, which had not been the case in the immediate posttransplant period, and addition of lisinopril worsened his renal function. Transplant renal artery stenosis was suspected, and allograft ultrasound with doppler confirmed our suspicion. The patient underwent an angiogram, showing 60% stenosis of the mid-distal transplanted renal artery. Interventional radiology successfully stented this lesion, with subsequent improvement in allograft function and blood pressure control. He did not require further intervention in follow-up.
一位 41 岁的终末期肾病患者在无并发症的情况下接受了已故供体的肾移植。维持性免疫抑制方案包括他克莫司、霉酚酸酯和泼尼松。移植后两个月，他的肌酐水平仍未改善至 2-2.3mg/dL 以上，因此进行了移植肾活检。他的活检显示肾小管上皮损伤而无排斥反应，鉴于可能存在钙调磷酸酶抑制剂毒性，将他克莫司换为西罗莫司。肾功能有所改善，但 1 个月后，他因癫痫发作、严重高血压、急性肾损伤和 MRI 表现提示后部可逆性脑病综合征而住院。尽管在移植后早期血压难以控制，但加用赖诺普利后他的肾功能恶化。怀疑移植肾动脉狭窄，并通过移植肾超声加多普勒证实了我们的怀疑。患者接受了血管造影检查，显示中远端移植肾动脉有 60%狭窄。介入放射科成功地对该病变进行了支架置入，随后移植肾功能和血压控制得到改善。在后续随访中，他无需进一步干预。
