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Atypical relapse of hemolytic uremic syndrome after transplantation

Lookup NU author(s): Dr Lisa Turnbull, Professor Tim Goodship


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Atypical hemolytic uremic syndrome (HUS) frequently leads to end-stage renal failure and can relapse after transplantation. A 12-year-old girl presenting with familial atypical HUS with a factor H mutation was successfully transplanted 6 years after a first transplant that had failed because of immediate recurrent HUS. Prophylactic plasma exchange before and after transplantation was used. Two months after transplantation, concomitant with a reduction in plasma exchange frequency, the plasma creatinine increased from 70 μmol/l to 194 μ mol/l in 2 weeks without thrombocytopenia or signs of hemolytic anemia. The patient had minimal clinical symptoms and a presumptive diagnosis of graft rejection was made. Despite treatment with six daily pulses of methylprednisolone, plasma creatinine continued to increase and a graft biopsy was therefore undertaken. This showed the typical appearance of a thrombotic microangiopathy without any evidence of rejection. Despite daily plasmapheresis and replacement of cyclosporine with tacrolimus, there was no improvement and transplant nephrectomy was undertaken. This patient demonstrates that HUS can recur in a kidney transplant without the diagnostic hematological features and emphasizes the need for early transplant biopsy in such patients showing a decline in transplant function. © IPNA 2004.

Publication metadata

Author(s): Olie KH, Florquin S, Groothoff JW, Verlaak R, Strain L, Goodship THJ, Weening JJ, Davin J-C

Publication type: Article

Publication status: Published

Journal: Pediatric Nephrology

Year: 2004

Volume: 19

Issue: 10

Pages: 1173-1176

Print publication date: 01/10/2004

ISSN (print): 0931-041X

ISSN (electronic): 1432-198X

Publisher: Springer


DOI: 10.1007/s00467-004-1565-2

PubMed id: 15300478


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