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CN: Transplant Megalocytic Interstitial Nephritis

Posting on Nephrol From Anderson Roman Gonçalves, M.D.

29y old woman cadaver kidney transplanted 10 months earlier. She is in triple therapy (cyclosporine, azathioprine and prednisone). Three months ago she became to lose kidney function (creat 1,3mg/dl to 2,2 mg/dl) with high serum cyclosporine levels. There was an improvement with the decrease of the dosis (Cr 1,8 mg/dl). The kidney biopsy showed slight interstitial fibrosis. At this week the creatinine is 5,0 mg/dl but with low cyclosporine levels. Two days ago we performed a kidney biopsy that showed extensive interstitial fibrosis with some megalocytic cells in tubules, vasa and interstitium, without granuloma.  Would this be a megalocytic interstitial nephritis? The patient doesn't have urinary infection, pain, fever, worsening arterial hypertension (she is in use of nifedipine and atenolol since her previous dialysis).

Thank you very much.

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