Immune Complex Mediated Glomerulonephritis with Acute Thrombotic Microangiopathy following Newly Detected Hepatitis B Virus Infection in a Kidney Transplant Recipient
Hepatitis B virus (HBV) presents a risk to patients and staff in renal units. To minimise viral transmission, there are international and UK guidelines recommending HBV immunisation for patients commencing renal replacement therapy (RRT) and HBV surveillance in kidney transplant recipients. We repor...
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| Format: | Article |
| Language: | English |
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Wiley
2016-01-01
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| Series: | Case Reports in Transplantation |
| Online Access: | http://dx.doi.org/10.1155/2016/3152495 |
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| _version_ | 1849693350467207168 |
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| author | Tracey Salter Hannah Burton Sam Douthwaite William Newsholme Catherine Horsfield Rachel Hilton |
| author_facet | Tracey Salter Hannah Burton Sam Douthwaite William Newsholme Catherine Horsfield Rachel Hilton |
| author_sort | Tracey Salter |
| collection | DOAJ |
| description | Hepatitis B virus (HBV) presents a risk to patients and staff in renal units. To minimise viral transmission, there are international and UK guidelines recommending HBV immunisation for patients commencing renal replacement therapy (RRT) and HBV surveillance in kidney transplant recipients. We report the case of a 56-year-old male who was immunised against HBV before starting haemodialysis. He received a deceased donor kidney transplant three years later, at which time there was no evidence of HBV infection. After a further six years he developed an acute kidney injury; allograft biopsy revealed an acute thrombotic microangiopathy (TMA) with glomerulitis, peritubular capillaritis, and C4d staining. Due to a “full house” immunoprofile, tests including virological screening were undertaken, which revealed acute HBV infection. Entecavir treatment resulted in an improvement in viral load and kidney function. HBV genotyping demonstrated a vaccine escape mutant, suggesting “past resolved” infection that reactivated with immunosuppression, though posttransplant acquisition cannot be excluded. This is the first reported case of acute HBV infection associated with immune complex mediated glomerulonephritis and TMA. Furthermore, it highlights the importance of HBV surveillance in kidney transplant recipients, which although addressed by UK guidelines is not currently practiced in all UK units. |
| format | Article |
| id | doaj-art-329e8fd3ab2a4bdca26929620bea24e3 |
| institution | DOAJ |
| issn | 2090-6943 2090-6951 |
| language | English |
| publishDate | 2016-01-01 |
| publisher | Wiley |
| record_format | Article |
| series | Case Reports in Transplantation |
| spelling | doaj-art-329e8fd3ab2a4bdca26929620bea24e32025-08-20T03:20:27ZengWileyCase Reports in Transplantation2090-69432090-69512016-01-01201610.1155/2016/31524953152495Immune Complex Mediated Glomerulonephritis with Acute Thrombotic Microangiopathy following Newly Detected Hepatitis B Virus Infection in a Kidney Transplant RecipientTracey Salter0Hannah Burton1Sam Douthwaite2William Newsholme3Catherine Horsfield4Rachel Hilton5Departments of Nephrology and Transplantation, Guy’s and St Thomas’ NHS Foundation Trust, London, UKDepartments of Nephrology and Transplantation, Guy’s and St Thomas’ NHS Foundation Trust, London, UKDepartment of Virology, Guy’s and St Thomas’ NHS Foundation Trust, London, UKDepartment of Infectious Diseases, Guy’s and St Thomas’ NHS Foundation Trust, London, UKDepartment of Histopathology, Guy’s and St Thomas’ NHS Foundation Trust, London, UKDepartments of Nephrology and Transplantation, Guy’s and St Thomas’ NHS Foundation Trust, London, UKHepatitis B virus (HBV) presents a risk to patients and staff in renal units. To minimise viral transmission, there are international and UK guidelines recommending HBV immunisation for patients commencing renal replacement therapy (RRT) and HBV surveillance in kidney transplant recipients. We report the case of a 56-year-old male who was immunised against HBV before starting haemodialysis. He received a deceased donor kidney transplant three years later, at which time there was no evidence of HBV infection. After a further six years he developed an acute kidney injury; allograft biopsy revealed an acute thrombotic microangiopathy (TMA) with glomerulitis, peritubular capillaritis, and C4d staining. Due to a “full house” immunoprofile, tests including virological screening were undertaken, which revealed acute HBV infection. Entecavir treatment resulted in an improvement in viral load and kidney function. HBV genotyping demonstrated a vaccine escape mutant, suggesting “past resolved” infection that reactivated with immunosuppression, though posttransplant acquisition cannot be excluded. This is the first reported case of acute HBV infection associated with immune complex mediated glomerulonephritis and TMA. Furthermore, it highlights the importance of HBV surveillance in kidney transplant recipients, which although addressed by UK guidelines is not currently practiced in all UK units.http://dx.doi.org/10.1155/2016/3152495 |
| spellingShingle | Tracey Salter Hannah Burton Sam Douthwaite William Newsholme Catherine Horsfield Rachel Hilton Immune Complex Mediated Glomerulonephritis with Acute Thrombotic Microangiopathy following Newly Detected Hepatitis B Virus Infection in a Kidney Transplant Recipient Case Reports in Transplantation |
| title | Immune Complex Mediated Glomerulonephritis with Acute Thrombotic Microangiopathy following Newly Detected Hepatitis B Virus Infection in a Kidney Transplant Recipient |
| title_full | Immune Complex Mediated Glomerulonephritis with Acute Thrombotic Microangiopathy following Newly Detected Hepatitis B Virus Infection in a Kidney Transplant Recipient |
| title_fullStr | Immune Complex Mediated Glomerulonephritis with Acute Thrombotic Microangiopathy following Newly Detected Hepatitis B Virus Infection in a Kidney Transplant Recipient |
| title_full_unstemmed | Immune Complex Mediated Glomerulonephritis with Acute Thrombotic Microangiopathy following Newly Detected Hepatitis B Virus Infection in a Kidney Transplant Recipient |
| title_short | Immune Complex Mediated Glomerulonephritis with Acute Thrombotic Microangiopathy following Newly Detected Hepatitis B Virus Infection in a Kidney Transplant Recipient |
| title_sort | immune complex mediated glomerulonephritis with acute thrombotic microangiopathy following newly detected hepatitis b virus infection in a kidney transplant recipient |
| url | http://dx.doi.org/10.1155/2016/3152495 |
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