Sait ŞEN, Reyhan YEĞEN, Ercan OK, Gülçin BAŞDEMİR

Böbrek transplantlı olguda ilaca bağlı akut interstisyel nefrit ve vaskülit: Olgu sunumu

Renal transplant yapıldıktan iki hafta sonra transplant böbrek disfonksiyonu nedeniyle böbrek biopsisi yapılan hastanın biopsisinde intimal arterit, şiddetli interstisyel yangısal infiltrasyon ve şiddetli tübülit saptandı. Vaskülit rejeksiyona özgü bir bulgu kabul edildiğinden olguya akut vasküler rejeksiyon (grade II b, Banff 93) tanısı kondu. Ancak klinik öntanıda yer alan ilaca bağlı akut interstisyel nefrit (AİN) tanısı ekarte edilemedi. Biopsi öncesi aldığı trimetoprim-sulfometoksazol (TMP-SMZ) tedavisi kesildi. Biopsi sonrası antirejeksiyon tedavi yapılmaksızın böbrek fonksiyonları düzelmeye başladı ve bazal değerlere indi. Klinikopatolojik gözlem böbrek patolojisinin ilaca bağlı geliştiğini (TMP-SMZ) ve olgunun ilaca bağlı AİN ve vaskülit olduğunu düşündürmektedir. Bu transplant böbrekte ilaca bağlı ilk vaskülit olgusudur. Beşinci yıl sonunda transplant böbrek fonksiyonu ve hasta iyi durumdadır.

Anahtar Kelimeler:

Böbrek nakli, Nefrit, Vaskülit, Biyopsi, Trimetoprim-sulfametoksazol kombinasyonu, Anomaliler, ilaca bağlı

Drug induced acute interstitial nephritis and vasculitis in renal allograft: Case report

Intimal arteritis, severe interstitial infiltration and severe tubulitis have been found in the renal allograft biopsy (RAB) of a patient who had acute renal allograft dysfunction after two weeks of renal transplantation. Since vasculitis is accepted as a finding of acute rejection, we have diagnosed the biopsy as acute vascular rejection (grade IIb, Banff 93). But drug induced acute interstitial nephritis (AIN) which was one of the clinical prediagnosis couldn't be excluded. Before the RAB, his trimethaprim-sulfamethoxazole (TMP-SMZ) treatment was discontinued. Renal functions began to improve and finally reached baseline without antirejection therapy after biopsy. Clinicopathological findings suggest that renal pathology has developed as a drug reaction (TMP-SMZ) and the patient has been evaluated as AIN and vasculitis due to drug use. This is the first vasculitis due to drug use of renal transplant patient. After five years of follow-up renal allograft functions are normal and the patient is well.

Keywords:

Kidney Transplantation, Nephritis, Vasculitis, Biopsy, Trimethoprim-Sulfamethoxazole Combination, Abnormalities, Drug-Induced,

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