tacrolimus and Pyelonephritis

Topics: Chronic Disease; Graft Rejection; Graft Survival; Humans; Immunosuppressive Agents; Kidney Function Tests; Kidney Transplantation; Male; Middle Aged; Pilot Projects; Prognosis; Pyelonephritis; Randomized Controlled Trials as Topic; Tacrolimus; Treatment Outcome

Common pathogens of clinically mild encephalitis/encephalopathy with a reversible splenial lesion (MERS) are viruses, such as influenza virus. However, bacteria are rare pathogens for MERS. We report the first patient with MERS associated with febrile urinary tract infection. A 16-year-old lupus patient was admitted to our hospital. She had fever, headache, vomiting, and right back pain. Urinary analysis showed leukocyturia, and urinary culture identified Klebsiella pneumoniae. Cerebrospinal fluid examination and brain single-photon emission computed tomography showed no abnormalities. Therefore, she was diagnosed with febrile urinary tract infection. For further examinations, 99mTc-dimercaptosuccinic acid renal scintigraphy showed right cortical defects, and a voiding cystourethrogram demonstrated right vesicoureteral reflux (grade II). Therefore, she was diagnosed with right pyelonephritis. Although treatment with antibiotics administered intravenously improved the fever, laboratory findings, and right back pain, she had prolonged headaches, nausea, and vomiting. T2-weighted, diffusion-weighted, and fluid attenuated inversion recovery images in brain magnetic resonance imaging showed high intensity lesions in the splenium of the corpus callosum, which completely disappeared 1 week later. These results were compatible with MERS. To the best of our knowledge, our patient is the first patient who showed clinical features of MERS associated with febrile urinary tract infection.. In patients with pyelonephritis and an atypical clinical course, such as prolonged headache, nausea, vomiting, and neurological disorders, the possibility of MERS should be considered.

Topics: Adolescent; Encephalomyelitis; Female; Fever; Glucocorticoids; Humans; Immunosuppressive Agents; Kidney; Klebsiella Infections; Klebsiella pneumoniae; Magnetic Resonance Imaging; Prednisolone; Pyelonephritis; Radionuclide Imaging; Radiopharmaceuticals; Tacrolimus; Technetium Tc 99m Dimercaptosuccinic Acid; Urinary Tract Infections

ABO-incompatible renal transplantation (ABOi-RTx) following preconditioning with immunoadsorption (IA) and rituximab is a promising approach to facilitate living-related RTx. However, clinical experience is limited in pediatric patients.. Three patients underwent living-related ABOi-RTx in our center. Preoperative IA was performed six, ten and 11 times in patient one, two and three, respectively, to achieve isoagglutinin titers of ≤1:8 on the day of transplantation; rituximab was administered once. The immunosuppressive regimen further comprised tacrolimus, mycophenolate, methylprednisolone and basiliximab; immunoglobulin G (IgG) was infused on the day of ABOi-RTx.. All three patients achieved normal renal function within 2-6 days post-RTx. Major postoperative bleeding occurred in two patients, with one requiring repeated blood transfusions and the other a surgical revision 4 h after RTx, despite local citrate anticoagulation use during the preoperative IA procedures in the latter patient. A pyelonephritis-associated increase of the isoagglutinin IgG/IgM titers to 1:64/1:128 led to a biopsy-proven acute humoral rejection in the third patient, which was treated successfully with plasma exchange and methylprednisolone pulses. The estimated glomerular filtration rate at 18, 8 and 23 months post-RTx was 96, 52 and 74 ml/min/1.73 m(2), respectively.. ABOi-RTx can successfully be performed in pediatric patients after preconditioning with quadruple immunosuppression, rituximab and IA. Caution is required regarding bleeding complications, which are most likely due to the unspecific binding of coagulation factors during repeated IA.

Topics: ABO Blood-Group System; Adolescent; Adult; Antibodies, Monoclonal; Antibodies, Monoclonal, Murine-Derived; Anticoagulants; Basiliximab; Blood Group Incompatibility; Child, Preschool; Glomerular Filtration Rate; Graft Rejection; Graft Survival; Heparin; Humans; Immunoglobulin G; Immunoglobulin M; Immunosorbent Techniques; Immunosuppressive Agents; Kidney Failure, Chronic; Kidney Transplantation; Methylprednisolone; Mycophenolic Acid; Postoperative Hemorrhage; Pyelonephritis; Recombinant Fusion Proteins; Rituximab; Tacrolimus; Young Adult

Topics: Acute Disease; Adolescent; Anti-Infective Agents, Urinary; Biopsy; Creatinine; Diagnosis, Differential; Graft Rejection; Humans; Immunosuppressive Agents; Kidney Transplantation; Male; Neutrophils; Ofloxacin; Pseudomonas Infections; Pyelonephritis; Tacrolimus; Time Factors