Hemophagocytic syndrome or hemophagocytic lymphohistiocytosis (HLH) is an infrequent and underdiagnosed condition caused by an overactive immune response, resulting in blood cells phagocytosis. After kidney transplantation (KTx), HLH is usually secondary (or reactive) to infectious and neoplastic processes and has a high mortality rate. No effective treatment is available for this condition. Usual procedures include detecting and treating the pathology triggering the immune system dysregulation, other than administration of intravenous human immunoglobulin (IVIG) and high doses of steroids, and plasmapheresis. The best protocol for maintenance immunosuppressive therapy is also unknown. This article presents two cases of post-KTx reactive HLH that underwent adjuvant IVIG treatment and obtained good clinical results. Despite the high morbidity and mortality associated with reactive HLH after KTx, the early and precise diagnosis and the administration of IVIG therapy along with the treatment of the triggering disease, was an effective strategy to control HLH.
pro-inflammatory and prothrombotic state that might be detrimental for the course of COVID-19. These data should prompt further studies to define optimal management strategies of COVID-19 in solid organ transplant recipients with HIV infection. b Last available test before COVID-19 diagnosis. c Patient admitted on February 20, 2020 for kidney transplant surgery. d Patient with delayed graft function when COVID-19 was diagnosed. e de novo glomerulonephritis. f Patient admitted on April 16, 2020 to treat urinary tract infection. g Nonimmune interstitial fibrosis/tubular atrophy.
A nefropatia diabética (ND) é atualmente a principal causa da doença renal em estágio terminal (DRET), na Europa e Estados Unidos, e a segunda causa, no Brasil. A recorrência histológica da nefropatia diabética tem sido descrita em cerca de 40% dos pacientes, sendo o diagnóstico de recorrência realizado em média de 6-8 anos pós-transplante renal, mas, com relatos de recorrência tão precoce como dois anos. Relatamos o caso de um paciente com diagnóstico prévio de diabetes mellitus que foi submetido a transplante renal com doador falecido e evoluiu à recorrência de nefropatia diabética, no primeiro ano após transplante, com diagnóstico de certeza, somente após biópsias repetidas.
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