Immune Complex Mediated Glomerulonephritis with Acute Thrombotic Microangiopathy following Newly Detected Hepatitis B Virus Infection in a Kidney Transplant RecipientReport as inadecuate




Immune Complex Mediated Glomerulonephritis with Acute Thrombotic Microangiopathy following Newly Detected Hepatitis B Virus Infection in a Kidney Transplant Recipient - Download this document for free, or read online. Document in PDF available to download.

Case Reports in Transplantation - Volume 2016 2016, Article ID 3152495, 5 pages -

Case Report

Departments of Nephrology and Transplantation, Guy’s and St Thomas’ NHS Foundation Trust, London, UK

Department of Virology, Guy’s and St Thomas’ NHS Foundation Trust, London, UK

Department of Infectious Diseases, Guy’s and St Thomas’ NHS Foundation Trust, London, UK

Department of Histopathology, Guy’s and St Thomas’ NHS Foundation Trust, London, UK

Received 5 June 2016; Accepted 8 September 2016

Academic Editor: David Conti

Copyright © 2016 Tracey Salter et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Hepatitis B virus HBV presents a risk to patients and staff in renal units. To minimise viral transmission, there are international and UK guidelines recommending HBV immunisation for patients commencing renal replacement therapy RRT and HBV surveillance in kidney transplant recipients. We report the case of a 56-year-old male who was immunised against HBV before starting haemodialysis. He received a deceased donor kidney transplant three years later, at which time there was no evidence of HBV infection. After a further six years he developed an acute kidney injury; allograft biopsy revealed an acute thrombotic microangiopathy TMA with glomerulitis, peritubular capillaritis, and C4d staining. Due to a -full house- immunoprofile, tests including virological screening were undertaken, which revealed acute HBV infection. Entecavir treatment resulted in an improvement in viral load and kidney function. HBV genotyping demonstrated a vaccine escape mutant, suggesting -past resolved- infection that reactivated with immunosuppression, though posttransplant acquisition cannot be excluded. This is the first reported case of acute HBV infection associated with immune complex mediated glomerulonephritis and TMA. Furthermore, it highlights the importance of HBV surveillance in kidney transplant recipients, which although addressed by UK guidelines is not currently practiced in all UK units.





Author: Tracey Salter, Hannah Burton, Sam Douthwaite, William Newsholme, Catherine Horsfield, and Rachel Hilton

Source: https://www.hindawi.com/



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