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Infliximab as long-term maintenance in steroid-resistant and recurrent sarcoidosis in a renal transplant with central nervous system involvement.

Srivastava S, Rajakariar R, Ashman N, Raftery M, Brown H, Martin JE - Clin Kidney J (2012)

Bottom Line: Sarcoidosis is a multisystemic, granulomatous disease of unknown aetiology, which commonly involves the lungs, skin and the eyes.Renal sarcoidosis is rare.We describe successful resolution of granulomas in the transplant kidney and stabilization of renal function with catastrophic central nervous system recurrence upon withdrawal of infliximab.

View Article: PubMed Central - PubMed

Affiliation: Renal Unit,The Royal London Hospital, London.

ABSTRACT
Sarcoidosis is a multisystemic, granulomatous disease of unknown aetiology, which commonly involves the lungs, skin and the eyes. Renal sarcoidosis is rare. Recurrent renal sarcoidosis leading to transplant graft failure in adults has not been reported. We report a single case of steroid-resistant sarcoid with recurrence in a renal transplant and the central nervous system that was managed with infliximab. We describe successful resolution of granulomas in the transplant kidney and stabilization of renal function with catastrophic central nervous system recurrence upon withdrawal of infliximab.

No MeSH data available.


Related in: MedlinePlus

Severe tubular atrophy and scarring with active granulomatous tubulointerstitial nephritis.
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fig2: Severe tubular atrophy and scarring with active granulomatous tubulointerstitial nephritis.

Mentions: He received a heart-beating deceased donor kidney the same year and was given standard immunosuppression with cyclosporin, mycophenolate mofetil (MMF) and prednisolone with no induction. He had stable graft function (serum creatinine ∼100 mmol/L) for 4 months when his serum creatinine climbed to 160 mmol/L. A transplant renal biopsy showed recurrence of sarcoidosis in his transplant kidney (Figure 1). The transplant biopsy was negative for C4d staining and no donor-specific antigens were detected in the patient’s serum. There was no evidence of infectious causes of granulomatous disease. He was pulsed with methylprednisolone (500 mg) and the subsequent dose of prednisolone was increased to 20 mg. The serum creatinine fell to 139 mmol/L. Due to lack of further improvement in renal function, a biopsy was repeated 2 months later (Figure 2).


Infliximab as long-term maintenance in steroid-resistant and recurrent sarcoidosis in a renal transplant with central nervous system involvement.

Srivastava S, Rajakariar R, Ashman N, Raftery M, Brown H, Martin JE - Clin Kidney J (2012)

Severe tubular atrophy and scarring with active granulomatous tubulointerstitial nephritis.
© Copyright Policy - creative-commons
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4400454&req=5

fig2: Severe tubular atrophy and scarring with active granulomatous tubulointerstitial nephritis.
Mentions: He received a heart-beating deceased donor kidney the same year and was given standard immunosuppression with cyclosporin, mycophenolate mofetil (MMF) and prednisolone with no induction. He had stable graft function (serum creatinine ∼100 mmol/L) for 4 months when his serum creatinine climbed to 160 mmol/L. A transplant renal biopsy showed recurrence of sarcoidosis in his transplant kidney (Figure 1). The transplant biopsy was negative for C4d staining and no donor-specific antigens were detected in the patient’s serum. There was no evidence of infectious causes of granulomatous disease. He was pulsed with methylprednisolone (500 mg) and the subsequent dose of prednisolone was increased to 20 mg. The serum creatinine fell to 139 mmol/L. Due to lack of further improvement in renal function, a biopsy was repeated 2 months later (Figure 2).

Bottom Line: Sarcoidosis is a multisystemic, granulomatous disease of unknown aetiology, which commonly involves the lungs, skin and the eyes.Renal sarcoidosis is rare.We describe successful resolution of granulomas in the transplant kidney and stabilization of renal function with catastrophic central nervous system recurrence upon withdrawal of infliximab.

View Article: PubMed Central - PubMed

Affiliation: Renal Unit,The Royal London Hospital, London.

ABSTRACT
Sarcoidosis is a multisystemic, granulomatous disease of unknown aetiology, which commonly involves the lungs, skin and the eyes. Renal sarcoidosis is rare. Recurrent renal sarcoidosis leading to transplant graft failure in adults has not been reported. We report a single case of steroid-resistant sarcoid with recurrence in a renal transplant and the central nervous system that was managed with infliximab. We describe successful resolution of granulomas in the transplant kidney and stabilization of renal function with catastrophic central nervous system recurrence upon withdrawal of infliximab.

No MeSH data available.


Related in: MedlinePlus