ACUTE FOCAL BACTERIAL NEPHRITIS PRESENTED AS ACUTE-RENAL-FAILURE AND HEPATIC-DYSFUNCTION IN A RENAL-TRANSPLANT RECIPIENT

We describe acute focal bacterial nephritis (AFBN) presented as acute renal failure and hepatic dysfunction in a renal transplant recipient. He had received a renal transplantation 5 years previously and mainta ined good renal function without an episode of acute rejection or any urinary abnormalities. He had been an HBsAg carrier and showed mild el evation of liver enzymes after renal transplantation. For 5 days befor e admission, the patient suffered from fever, graft kidney swelling, t enderness and oliguria. On admission, renal biopsy was performed and s olumedrol pulse therapy was started under the impression of acute reje ction. The following laboratory findings revealed acute renal failure and hepatic dysfunction. From the abdomen CT and renal biopsy findings this case was confirmed as AFBN in a grafted kidney. With successive hemodialysis and antibiotic therapy clinical symptoms and renal functi on improved promptly. In acute hepatic dysfunction we discontinued cyc losporine (CsA) to prevent irreversible fulminant hepatic failure unti l the normalization of liver function. It should be considered that AF BN must be included in the differential diagnosis of acute rejection, and the early diagnosis and treatment of AFBN is important to save the grafted kidney. In addition, early withdrawal of CsA is essential to prevent irreversible hepatic failure when infection triggers hepatic d ysfunction in HBsAg-positive renal transplant recipients.