Successful Graft Recovery from Thrombotic Acute Kidney Injury in a Kidney Transplant Patient with Antiphospholipid Syndrome

Younjeong Choi; Hyewon Lee; Yujung Yun; Youngki Lee; Eudong Hwang; Hyeonjoo Jeong; Beom Seok Kim

doi:10.4285/jkstn.2013.27.3.128

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Choi, Lee, Yun, Lee, Hwang, Jeong, and Kim: Successful Graft Recovery from Thrombotic Acute Kidney Injury in a Kidney Transplant Patient with Antiphospholipid Syndrome

Case Report

J Korean Soc Transplant 2013;27(3):128-131.

Published online: 11 September 2013

DOI: https://doi.org/10.4285/jkstn.2013.27.3.128

Successful Graft Recovery from Thrombotic Acute Kidney Injury in a Kidney Transplant Patient with Antiphospholipid Syndrome

Younjeong Choi, M.D.¹, Hyewon Lee, M.D.¹, Yujung Yun, M.D.¹, Youngki Lee, M.D.¹, Eudong Hwang, M.D.¹, Hyeonjoo Jeong, Ph.D.², Beom Seok Kim, Ph.D.¹

¹Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea

²Department of Pathology, Yonsei University College of Medicine, Seoul, Korea

Correspondence Beom Seok Kim, Division of Nephrology, Department of Internal Medicine, Yonsei University College of Medicine, 50 Yonsei-ro, Seodae-mun-gu, Seoul 120-749, Korea Tel: +82-2-2228-1969, Fax: +82-2-393-6884 E-mail: docbsk@yuhs.ac

Received 14 April 201316 July 2013 Accepted 7 August 2013

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Antiphospholipid syndrome nephropathy (APSN) is well documented in the literature as the renal involvement of the antiphospholipid syndrome (APS). A review of literature also shows that among antiphospholipid antibodies, lupus anticoagulant (LA) positivity is recognized as the strongest risk factor for APSN. In addition, APSN is also known to be associated with a poor functional outcome in the first posttransplant year. Therefore, it is a general belief that renal transplantation may be life threatening in APS patients. Furthermore, the presence of LA at the time of transplantation is particularly associated with a high rate of allograft APSN and the consequent poor transplantation outcomes. Here, we report the case that thrombotic acute kidney injury due to APSN after kidney transplantation can be successfully treated if anticoagulation therapy is timely applied with a prompt diagnosis.

Keywords: Antiphospholipid syndrome nephropathy, Antiphospholipid syndrome, Antiphospholipid antibodies, Lupus coagulation inhibitor, Kidney transplantation

REFERENCES

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Fig. 1.

Echocardiogram showing right atrium thrombus. After re-moval via submammrial incision, thrombus was disappeared.

Fig. 2.

The biopsy slide of transplanted kidney showing cortical necrosis, focal (postoperative day 8) (A, HE stain, ×120; B, PAS stain,×120).

Fig. 3.

Sonography of transplanted kidney (postoperative day 15). The transplanted kidney size was 11.4 cm. The echogenicity of the cortex was increased and blood flow was decreased. The resistive index of upper, mid, and lower pole was 0.56.

Fig. 4.

Change of renal function. After anticoagulation therapy was started the transplanted kidney function was improved. Abbreviations: eGFR, epidermal growth factor receptor; POD, postoperative day.

Fig. 5.

Sonography of transplanted kidney (postoperative day 3 months). The transplanted kidney size was 11.8 cm. The echogenicity of the cortex was normal and there was no hydronephrosis was no hydronephrosis or fluid collection. The resistive index of upper, mid, and lower pole was 0.60∼0.64.

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