PubMed · 5190367
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J F Bach. [Glomerulonephritis].. https://pubmed.ncbi.nlm.nih.gov/5190367/
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Improved graft survival is accompanied by complications which interfere with the long-term function of the allograft. Recurrence of the primary renal disease in the graft is well recognized and is found in 10 to 20% of all recipients; however, graft loss due to recurrent disease is reported in less than 5% of all cases. The most frequent cause of recurrence is glomerulonephritis: Membrano-proliferative GN type II, IgA nephritis and focal sclerosis are frequently observed. Among metabolic disorders linked to graft disease, diabetic nephropathy has to be mentioned first. Primary oxalosis is a rare disorder, but it is related to a very high risk of recurrent disease in the transplant. Combined kidney-liver transplantation seems to offer a valuable alternative for these patients. The high risk of recurrence of certain diseases, i.e. membrano-proliferative GN type II, focal-segmental glomerulosclerosis, primary oxalosis, should prevent living donation. In addition, there are some reports suggesting that living-related donation might increase the recurrence rate of hemolytic-uremic syndrome, membranous GN and Schönlein-Henoch purpura. Recurrent disease might not only affect the outcome of the transplant, but can provide insight into the nature and pathogenesis of the primary disease. Currently there are no conclusive reports indicating that chronic immunosuppression, especially cyclosporin-A treatment, reduces recurrence rates; however the clinical course might be ameliorated.
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We present the case of a 59 years old male with Wegener's Granulomatosis with uncommon manifestations such as diffuse pulmonary hemorrhage and acute renal failure due to necrotizing glomerulonephritis. Neutrophil anticytoplasmic antibodies determination was negative. Conventional and high resolution thoracic computed tomography showed cavitated lung nodules with small peripheral vessels. These lesions, that are characteristic of this type of vasculitis, were not appreciated on the routine chest roetgenogram. Definitive diagnosis was made by the histological study of open lung and renal biopsies. Favourable response to corticosteroids, immunosuppressive drugs and hemodialysis was obtained. Diffuse pulmonary hemorrhage is an uncommon manifestation of Wegener's Granulomatosis, and must be considered as a vital emergency that justify the use of aggressive diagnostic and therapeutic methods.