Background: Post-transplant diabetes mellitus (PTDM) is an emerging problem in kidney transplantation,\nrepresenting an important risk factor for kidney function loss. Diabetic nephropathy (DN) occurrence in transplanted\nkidneys is poorly investigated. Current knowledge describes DN recurrence in graft 5.9 years from kidney\ntransplantation however there is little data about PTDM and DN.\nHere, we report a clinical case peculiar for an early appearance of advanced glomerular diabetic lesions, after kidney\ntransplantation.\nCase presentation: A 45-year-old Caucasian male affected by autosomal polycystic kidney disease was\ntransplanted with a cadaveric-kidney-donor from 58-year-old male. Induction immunosuppressive therapy included\nbasiliximab and steroids while the maintenance treatment included, tacrolimus, mofetil micophenolate and\nmethylprednisolone.\nOne month after transplantation the patient developed diabetes requiring treatment with repaglinide quickly\nreplaced with insulin to obtain an acceptable glycemic control (HbA1c 52 mmol/mol). Glycosuria was detected\npersistently during the first six months after transplantation. To achieve further improvement in glycemic control, a\nshift from tacrolimus to cyclosporine (CyA) was made and steroids were rapidly tapered and stopped. To minimize\ncalcineurin inhibitors toxicity, which was revealed in the 1-year-protocol-biopsy, everolimus was introduced thereby\nlowering CyA through levels. Moderate hypertension was well controlled with doxazosin. Thirty months after\ntransplantation a second graft biopsy was performed owing to renal function decline and microalbuminuria\nappearance. Histological analysis surprisingly showed mesangiolysis and microaneurysms; glomerular sclerohyalinosis\nand basal membrane thickness and typical nodular glomerulosclerosis. C4d staining was negative and no\nevidence of immune deposits were detected. Donor Specific Antibodies, serum C3 and C4 levels and autoimmunity\ntests were negative. Retrospective analysis on donor history didnâ??t show diabetes or insulin resistance and no\ndiabetic lesions were found in kidney pre-implant biopsy.\nConclusions: In our knowledge, this is the first report describing a very early onset of advanced diabetic\nglomerular lesions in a graft biopsy after PTDM. We hypothesize that additional factors such as everolimus and\nhypertension, may have contribute to kidney damage.
Loading....