The classical triad of hemolytic uremic syndrome (microangiopathic hemolytic anemia, severe thrombopenia, and renal failure) developed de novo in three of our renal transplanted patients under cyclosporin A treatment. The predominant morphologic findings in the grafts consisted of glomerular and arteriolar thrombosis as well as arteriolonecrosis, all features of the syndrome. In one instance, ischemic bowel disease supervened after graft removal and was associated with persistent low grade microangiopathic process. De novo hemolytic uremic syndrome has been reported in patients treated with cyclosporin A following bone marrow or liver transplantation as well as in a few renal graft recipients. This peculiar form of cyclosporin A nephrotoxicity should not be confused with acute rejection of the renal transplant.
The records of 22 patients in whom wall thickening of the renal collecting system was seen at ultrasound (US) were retrospectively reviewed. Wall thickening was found in 15 patients with renal transplants and seven with native kidneys. Severe thickening occurred with transplant rejection, but thickening also occurred with urinary tract infection, reflux, or chronic obstruction in both transplanted and native kidneys. As such, thickening of the renal collecting system seen at US is a nonspecific finding that must be correlated with the clinical and laboratory findings.
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