J Korean Soc Transplant.  2013 Sep;27(3):128-131. 10.4285/jkstn.2013.27.3.128.

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

• Choi Y
• Lee H
• Yun Y
• Lee Y
• Hwang E
• Jeong H
• Kim BS

• KMID: 1495870
• DOI: http://doi.org/10.4285/jkstn.2013.27.3.128

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.

Keyword

Antiphospholipid syndrome nephropathy; Antiphospholipid syndrome; Antiphospholipid antibodies; Lupus coagulation inhibitor; Kidney transplantation

MeSH Terms

Acute Kidney Injury
Antibodies, Antiphospholipid
Antiphospholipid Syndrome
Humans
Kidney
Kidney Transplantation
Lupus Coagulation Inhibitor
Risk Factors
Transplantation, Homologous
Transplants
Antibodies, Antiphospholipid
Lupus Coagulation Inhibitor

Figure

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  Fig. 1. Echocardiogram showing right atrium thrombus. After re-moval via submammrial incision, thrombus was disappeared.

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  Fig. 2. The biopsy slide of transplanted kidney showing cortical necrosis, focal (postoperative day 8) (A, HE stain, ×120; B, PAS stain,×120).

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  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.

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  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.

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  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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