De novo ANCA-associated vasculitis occurring 14 years after kidney transplantation

A cadaveric kidney transplant recipient, with no history of a connective ti ssue disease, was admitted with malaise, arthralgias, diplopia, mild headac he, and a painful left eye. The patient was on maintenance immunosuppressio n for 14 years with cyclosporine and methylprednisolone. Initial laboratory data indicated an elevated serum creatinine from baseline, 2+ proteinuria, and 50 to 100 red blood cells (RBCs)/high-power field (HPF) in the urine. Renal biopsy was consistent with necrotizing vasculitis involving glomerula r capillaries, with crescent formation and an absence of immune complexes. Perinuclear antineutrophil cytoplasmic autoantibodies (P-ANCA) and anti-mye loperoxidase (MPO) were found to be elevated. To the best of our knowledge, this is the first reported case of an ANCA-associated small vessel vasculi tis (SVV) developing in a renal transplant recipient without history of con nective tissue disease. (C) 2000 by the National Kidney Foundation, Inc.