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A case of atypical hemolytic uremic syndrome in a second renal transplant

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Abstract

Atypical hemolytic uremic syndrome (aHUS) has gained increased visibility over several years as an important cause of renal failure. Unfortunately, diagnosis is often difficult because individual courses can be highly variable depending the causative genetic mutations. Here we present the case of a patient with a failed renal allograft and acute failure of a second allograft who was ultimately diagnosed with aHUS. Interestingly, he developed early de novo donor specific antibodies (DSA) after the second renal transplant in context of likely recurrent aHUS. Terminal complement inhibition with eculizumab resulted in prompt improvement of renal allograft function.

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Notes

  1. Recipient HLA typing was as follows: A11, A24, B18, B35, DR4, DR53 (there was no C, DQ or DP tying for the recipient). Donor HLA typing was as follows: A2, A68, B53, C4, DR13, DR16, DQ2, and DQ5 (there was no donor DP typing).

  2. Recipient HLA typing was as follows: A11, A24, B18, B35, DR4, DR53 (there was no C, DQ or DP tying for the recipient). Donor HLA typing was as follows: A1, A24, B7, B62, C7, C10, DR4, DR53, DQ8, DP3, and DP14. There was no history of Class II donor specific antibodies pre- or post-transplant.

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Acknowledgements

We would specifically like to thank Lisa Scholz, RN, MS for her continuity care of this patient. The authors would like to thank the faculty and staff of the Comprehensive Transplant Center of Northwestern Memorial Hospital.

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Authors and Affiliations

  1. Comprehensive Transplant Center, Northwestern University Feinberg School of Medicine, Chicago, USA

    Nicholas A. Zwang, Bing Ho, Matthew Cusick, John J. Friedewald & Lorenzo Gallon

  2. McGaw Medical Center of Northwestern University, Chicago, USA

    Nicholas A. Zwang & John J. Friedewald

  3. Department of Pathology, Northwestern Memorial Hospital, Chicago, USA

    Yashpal S. Kanwar & John J. Friedewald

  4. Machaon Diagnostics, Oakland, CA, USA

    Brad Lewis & John J. Friedewald

  5. Northwestern Memorial Hospital/Arkes Family Pavilion Suite 1900, 676N. St. Clair, Chicago, IL, 60611, USA

    Nicholas A. Zwang & John J. Friedewald

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  1. Nicholas A. Zwang
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  2. Bing Ho
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  3. Yashpal S. Kanwar
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Correspondence to Nicholas A. Zwang.

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Dr. Gallon has a consulting and advisory relationship with Alexion Pharmaceuticals, Inc. The other authors declare no conflicts of interest.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Informed consent was obtained from all individual participants included in the study.

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Zwang, N.A., Ho, B., Kanwar, Y.S. et al. A case of atypical hemolytic uremic syndrome in a second renal transplant. J Nephrol 31, 165–172 (2018). https://doi.org/10.1007/s40620-016-0373-7

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  • DOI: https://doi.org/10.1007/s40620-016-0373-7

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