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Recurrent lupus nephritis in renal allograft triggered by pregnancy

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Abstract

Herein we report the case of a 37-year-old woman with recurrence of lupus nephritis (LN) in a renal allograft during pregnancy. She had developed end-stage renal disease due to LN and was put on hemodialysis at the age of 26 years. She underwent kidney transplantation at the age 28 years. Maintenance immunosuppressants included methylprednisolone, tacrolimus, and mycophenolate mofetil, which were changed to azathioprine when she desired pregnancy. The renal allograft function remained stable and seemingly disease-free until proteinuria and functional decline occurred during the pregnancy (age: 34 years). The baby was delivered by performing a cesarean section at 33 weeks of gestation. Renal allograft biopsy revealed crescent formation. Light microscopy revealed tuft necrosis and endocapillary proliferation. Immunofluorescence microscopy revealed the deposition of immunoglobulin G and C1q. A recurrence of LN (ISN/RPS class IV-G [A/C]) was diagnosed, and the patient was treated with pulse steroid therapy and azathioprine was replaced with mycophenolate mofetil. This treatment improved acute or active lesions of LN and temporarily benefited the renal allograft function. Unfortunately, there were irreversible chronic changes and a gradual decline in the renal allograft function.

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Authors and Affiliations

  1. Department of Nephrology, Shizuoka General Hospital, 4-27-1 Kitaandohigashi, Aoi-Ku, Shizuoka, Shizuoka, 4208527, Japan

    Takahiro Shinzato

  2. Department of Gastroenterological and General Surgery, Showa University Hospital, Tokyo, Japan

    Toshihiro Shimizu

  3. Department of Renal Surgery and Transplantation, Jichi Medical University Hospital, Shimotsuke, Japan

    Daiki Iwami

  4. Department of Diagnostic Pathology, Jichi Medical University Hospital, Shimotsuke, Japan

    Noriyoshi Fukushima & Kenichi Tabata

Authors
  1. Takahiro Shinzato
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  2. Toshihiro Shimizu
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  3. Daiki Iwami
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  4. Noriyoshi Fukushima
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  5. Kenichi Tabata
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Correspondence to Takahiro Shinzato.

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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 at which the studies were conducted (IRB approval number RIN A19-097) and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Shinzato, T., Shimizu, T., Iwami, D. et al. Recurrent lupus nephritis in renal allograft triggered by pregnancy. CEN Case Rep 11, 237–241 (2022). https://doi.org/10.1007/s13730-021-00659-x

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  • DOI: https://doi.org/10.1007/s13730-021-00659-x

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