BackgroundSteroid-resistant nephrotic syndrome (SRNS) is an important cause of chronic kidney disease (CKD) in children that often progresses to end-stage renal disease (ESRD). Calcineurin inhibitors (CNIs) have been shown to be effective in inducing short-term remission in some patients with SRNS. However, there are little data examining their long-term impact on ESRD progression rates.MethodsWe performed a retrospective chart review of all patients treated for SRNS with CNIs at our institution from 1995 to 2013. Data collected including demographics, initial response to medical therapy, number of relapses, progression to ESRD, and treatment complications.ResultsA total of 16 patients met inclusion criteria with a mean follow-up of 6.6 years (range 0.6–17.6 years). Histopathological diagnoses were focal segmental glomerulosclerosis (8), mesangial proliferative glomerulonephritis (4), IgM nephropathy (3), and minimal change disease (1). Three patients (18.8%) were unresponsive to CNIs while the remaining 13 (81.2%) achieved remission with CNI therapy. Six patients (37.5%) progressed to ESRD during the study period, three of whom did so after initially responding to CNI therapy. Renal survival rates were 87, 71, and 57% at 2, 5, and 10 years, respectively. Non-Caucasian ethnicity was associated with progression to ESRD. Finally, a higher number of acute kidney injury (AKI) episodes were associated with a lower final estimated glomerular filtration rate.DiscussionDespite the majority of SRNS patients initially responding to CNI therapy, a significant percentage still progressed to ESRD despite achieving short-term remission. Recurrent episodes of AKI may be associated with progression of CKD in patients with SRNS.

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Fever in a kidney transplant recipient can be due to a variety of infections in the post-transplant period. Infection in the first month after solid organ transplant is primarily due to nosocomial bacterial or candidal infections and donor-derived infections. Opportunistic infections including viruses (Epstein-Barr virus [EBV], cytomegalovirus [CMV], and parvovirus), fungi, and Pneumocystis jiroveci are more common after the first post-transplant month. 1 Zoonotic infections, such as ehrlichiosis, are an uncommon cause of acute febrile illness in the immediate post-transplant period. Ehrlichiosis is a tick-borne illness caused by three genera: Ehrlichia, Anaplasma, and Neoehrlichia. 2,3 Ehrlichia chaffeensis is an obligate intracellular bacterium that infects monocytes and causes human monocytotropic ehrlichiosis (HME) and is transmitted by the bite of the lone star tick (Amblyomma americanum). HME occurs predominantly in the southcentral and southeastern United States 3 and demonstrates seasonal variability, with the majority of cases

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