Glomerulonephritis Renal transplant

Segerer S, Regele H, Mack M, et al. The duffy antigen receptor for chemokines is up-regulated during acute renal transplant rejection and crescentic glomerulonephritis. Kidney Int 2000 58 1546-1556. 

Azathioprine is an effective agent in suppressing the immune system in patients undergoing renal transplantation and in patients suffering from acute glomerulonephritis, the renal component of systemic lupus erythematosus, prednisone-resistant idiopathic thrombocytopenic purpura, and functioning autoimmune hemolytic anemia. Azathioprine depresses bone marrow functioning, which is its chief side effect. 

D) He had glomerulonephritis at age 24 and developed chronic renal failure but received a kidney transplant 10 years ago. 

The main clinical uses of immunosuppressive drugs are suppression of organ and tissue rejection after transplant surgery and the treatment of diseases with an autoimmune component. Thses include renal diseases, e.g. glomerulonephritis, some nephrotic syndromes, connective tissue diseases, such as systemic lupus erythematosus rheumatoid arthritis, and systemic vasculitis. 

Azathioprine and mercaptopurine appear to be of definite benefit in maintaining renal allografts and may be of value in transplantation of other tissues. These antimetabolites have been used with some success in the management of acute glomerulonephritis and in the renal component of systemic lupus erythematosus. They have also proved useful in some cases of rheumatoid arthritis, Crohn s disease, and multiple sclerosis. The drugs have been of occasional use in prednisone-resistant antibody-mediated idiopathic thrombocytopenic purpura and autoimmune hemolytic anemias. 

The patient was a 35-year-old white male with a x-antitrypsin deficiency. He received a combined liver-kidney transplant for cirrhosis complicated by portal hypertension, renal insufficiency secondary to membranoproliferative glomerulonephritis, and combined restrictive and obstructive pulmonary disease at age 18 years. 

Zanetta G, Maurice-Estepa L, Mousson C, Justrabo E, Daudon M, Rifle G, Tanter Y. Foscarnet-induced crystal-hne glomerulonephritis with nephrotic syndrome and acute renal failure after kidney transplantation. Transplantation 1999 67(10) 1376-8. 

Other manifestations of mTOR inhibitor renal effects are delayed recovery from ischemic renal injury. In rats not on cyclosporine, siroiimus impairs recovery from acute renal ischemia [785]. Human series describe delayed recovery from post-transplant ischemic injury, and worsening function in glomerulonephritis in the presence of siroiimus [786-787]. Few studies have tested TAC and everoiimus for similar changes [788]. 

Desai A, Goldschmidt RA, Kim GC. Sequential development of pulmonary renal syndrome associated with c-ANCA 3 years after development of anti-GBM glomerulonephritis. Nephrol Dial Transplant 2007 22(3) 926-929. 

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