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Diagnosis of de novo localized thrombotic microangiopathy by surveillance biopsy

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Abstract

Thrombotic microangiopathy has been reported in association with calcineurin inhibitors and less frequently with sirolimus in renal transplant patients. The diagnosis of thrombotic microangiopathy is typically made by diagnostic biopsy in the setting of allograft dysfunction. The finding of thrombotic microangiopathy on surveillance biopsy without a significant elevation of baseline serum creatinine is unusual. The optimal treatment of this disorder remains controversial. Treatment strategies have included dose adjustment, drug substitution, plasmapheresis, and intravenous immunoglobulin G. We report a case of de novo thrombotic microangiopathy diagnosed by surveillance biopsy in a patient without hematologic abnormalities or elevated serum creatinine. This patient had resolution of the renal lesion following conversion from tacrolimus to sirolimus-based immunosuppression.

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Acknowledgements

This research was sponsored by a generous gift from Donald and Anna Waite.

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Authors and Affiliations

  1. Department of Pediatrics, University of Tennessee Health Science Center (UTHSC), Memphis, TN, USA

    M. Colleen Hastings, Robert J. Wyatt, Bettina H. Ault, Deborah P. Jones & Keith K. Lau

  2. Department of Surgery, University of Tennessee Health Science Center (UTHSC), Memphis, TN, USA

    A. Osama Gaber

  3. Department of Pathology, University of Tennessee Health Science Center (UTHSC), Memphis, TN, USA

    Lillian W. Gaber

  4. Children’s Foundation Research Center, Le Bonheur Children’s Medical Center, Room 301 WPT, 50 North Dunlap, Memphis, TN, 38103, USA

    M. Colleen Hastings, Robert J. Wyatt, Bettina H. Ault, Deborah P. Jones & Keith K. Lau

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  1. M. Colleen Hastings
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  2. Robert J. Wyatt
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  4. Deborah P. Jones
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  6. A. Osama Gaber
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  7. Lillian W. Gaber
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Correspondence to M. Colleen Hastings.

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Hastings, M.C., Wyatt, R.J., Ault, B.H. et al. Diagnosis of de novo localized thrombotic microangiopathy by surveillance biopsy. Pediatr Nephrol 22, 742–746 (2007). https://doi.org/10.1007/s00467-006-0392-z

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  • DOI: https://doi.org/10.1007/s00467-006-0392-z

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