Donor-Derived ALECT2 Amyloidosis and Recurrent Fibrillary Glomerulonephritis in a Transplant Allograft.

The occurrence of renal amyloidosis and fibrillary glomerulonephritis in the same biopsy specimen is exceptional and poses a diagnostic challenge. We describe the case of a non-Hispanic White patient with end-stage kidney disease due to fibrillary glomerulonephritis who received a second living donor kidney from a Hispanic individual. A 40-month-posttransplantation biopsy performed for an elevated serum creatinine level revealed interstitial congophilic deposits and glomerular noncongophilic fibrillary deposits, in addition to rejection.

Henoch-Schönlein purpura and recurrent renal failure.

We present an 18-year-old patient with Henoch-Schönlein purpura (HSP) who had multiple episodes of severe acute renal failure, including one episode for which he required hemodialysis for 2 months and a second episode for which dialysis was considered before his spontaneous recovery of renal function. Multiple treatment options, including steroids, mycophenolate mofetil, cyclophosphamide, and plasmapheresis, were tried but we could not confidently point to the utility of any of these measures. We highlight the unusual severity and lability of our patient's clinical course and how such a course makes the evaluation of treatment effectiveness extraordinarily difficult.

The broad spectrum of quality in deceased donor kidneys.

The quality of the deceased donor organ clearly is one of the most crucial factors in determining graft survival and function in recipients of a kidney transplant. There has been considerable effort made towards evaluating these organs culminating in an amendment to allocation policy with the introduction of the expanded criteria donor (ECD) policy. Our study, from first solitary adult deceased donor transplant recipients from 1996 to 2002 in the National Scientific Transplant Registry database, presents a donor kidney risk grade based on significant donor characteristics, donor-recipient matches and cold ischemia time, generated directly from their risk for graft loss.

Quinine induced HUS-TTP: an unusual presentation.

A 67-year-old white woman developed severe nausea, vomiting, diffuse abdominal cramping pain, and blurred vision followed by a syncopal episode after taking 1 tablet of quinine for leg cramps. Examination was significant for fever, elevated blood pressure, and confusion without any focal neurological deficits. Laboratory studies showed markedly elevated liver enzymes, elevated lactate dehydrogenase, anemia, thrombocytopenia, and acute renal failure.