Acute rejection presenting as nephrotic syndrome

Background. Early diagnosis and treatment of acute rejection is important t o prevent continued renal injury. Acute rejection most commonly presents wi th asymptomatic rise in serum creatinine. Proteinuria associated with acute rejection is well established; however, there is limited documentation of the presentation of acute rejection as nephrotic syndrome in the literature . Methods and Results. We report a renal transplant patient who presented wit h early onset nephrotic syndrome without change in serum creatinine, whose allograft biopsy confirmed acute glomerulitis and vascular rejection. Treat ment of the acute rejection was accompanied by resolution of the nephrotic syndrome. A second episode of acute rejection was also manifested as nephro tic range proteinuria. Conclusion. The nephrotic syndrome in early posttransplantation period shou ld prompt a work-up for acute rejection even in the absence of the common f indings of this complication.