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| The Causes of Diffuse Glomerular Sclerosis: Case History |
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| Department of Pathology, Yeungnam University College of Medicine, Korea |
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A 23-year-old man was admitted to the hospital because of general weakness for one month.
He had a transplant kidney one and a half years ago. He had been well until seven years earlier, when he began to experience the intermittent gross hematuria. But it was gone spontaneously. He was a business man and had no history of diabetes or hypertension or family history of renal diseases.
Six years before the current admission, he was admitted because of fever , sore throat and gross hematuria. Tonsils were enlarged and left frank pain was found. The temperature rose to 39 C. Urinalysis showed ++ protein, many red cells and many white cells. The urea nitrogen was 15.0 mg/dL and the creatinine 0.9 mg/dL . He was afebrile after receiving antibiotic theraphy. Four years before, he was readmitted for evaluating the persistent hematuria and proteinuria. The creatinine was 1.1 mg/dL and the 24-hour urine protein was 2.9 gm per day. Renal biopsy revealed IgA nephropathy. Three years before, he was readmitted because of lower leg edema. The urinalysis showed +++ protein, + glucose, many red cells and 0-1 white cell per high-power field. The urea nitrogen was 100 mg/dL and the creatinine was 15 mg/dL. The radiograph of the chest showed pulmonary edema. He had been treated by hemodialysis for nine months before transplantation.
One and a half years before current admission, a living related renal allograft was performed. The donor was his father, 66 years old, and whose body weight was 69 kg and height 172 cm. Those of recipient were 88 kg and 178 cm at that time. Two months after transplantation, immunosuppression had been maintained by cyclosporine 275 mg bid, prednisolone 15 mg qd and azathioprine 100 mg. The whole blood level of cyclosporine was 150-200 ng/ml. The urea nitrogen was 14 mg/dL and the creatinine 1.7 mg/dL. Urinalysis showed 6-10 red cells and 3-5 white cells per high power field. There were no protein or glucose.
One year after transplantation, proteinuria and hematuria were developed. The medication was cyclosporine 100 mg bid, prednisolone 5 mg qd and azathioprine 100 mg. The cyclosporine level was 180 ng/ml. The urea nitrogen was 14 mg/dL and the creatinine had been maintained about at 1.7-1.9 mg/dL. The 24-hour urine protein was 4.5 gm per day.
On examination the patient appeared frail and chronically ill. The urea nitrogen was 28.3 mg/dL and the creatinine rose to 2.5 mg/dL. Other hematologic and chemical data were within normal limits. The transplant renal biopsy was done. |
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