Open AccessRapamycin‐associated post‐transplantation glomerulonephritis and its remission after reintroduction of calcineurin‐inhibitor therapy
Author(s) -
Dittrich Elisabeth,
Schmaldienst Sabine,
Soleiman Afschin,
Hörl Walter H.,
Pohanka Erich
Publication year - 2004
Publication title -
transplant international
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.998
H-Index - 82
eISSN - 1432-2277
pISSN - 0934-0874
DOI - 10.1111/j.1432-2277.2004.tb00431.x
Subject(s) - calcineurin , immunosuppression , medicine , glomerulonephritis , transplantation , proteinuria , kidney transplantation , sirolimus , nephropathy , nephrology , immunology , urology , gastroenterology , kidney , endocrinology , diabetes mellitus
Rapamycin is a new immunosuppressive agent approved for maintenance therapy after kidney transplantation. It may allow calcineurin‐inhibitor‐free, nonnephrotoxic immunosuppression. We report, however, on four kidneytransplant recipients who developed post‐transplantation glomerulonephritis after conversion from a calcineurin‐inhibitor‐based immunosuppression to rapamycin. In all four patients nephrotic‐range proteinuria occurred 2–9 months after conversion to rapamycin. Renal biopsy confirmed membrano‐proliferative glomerulonephritis type 1 in one case, membranous glomerulonephritis in another and IgA‐nephropathy in two cases, respectively. Calcineurin‐inhibitorbased immunosuppression was reintroduced and resulted in complete remission of proteinuria and in stabilised renal function in all patients. We conclude that in the case of rapamycin‐associated post‐transplantation glomerulonephritis an attempt should be made to replace rapamycin by a calcineurin inhibitor.