Recurrent immunotactoid glomerulopathy in a kidney transplant recipient: Case report

Rationale: Immunotactoid glomerulopathy (ITG) is a rare glomerular disease characterized by protein deposition in hollow microtubules on electron microscopy. Patients may present with proteinuria, hematuria, hypertension, and renal insufficiency, and some patients even progress to end-stage renal disease (ESRD). In patients with ESRD, ITG recurs in more than 50% of patients after kidney transplantation; however, there is no clear treatment plan for these patients owing to the limited number of reported cases. Patient concerns: In this study, we report a case of a 58-year-old male who was admitted to our hospital with elevated blood creatinine with proteinuria. Diagnoses: Renal biopsy suggested membranoproliferative glomerulonephritis with findings suggestive of ITG on electron microscopy. Interventions: After the first diagnosis of renal insufficiency, the patient was treated with rituximab; however, the patient’s symptoms did not improve, and blood creatinine continued to increase. The patient progressed to ESRD, and 3 years later, kidney transplantation was performed. After surgery, he was regularly treated with tacrolimus, mycophenolate mofetil, and prednisone acetate for antirejection. Five months after surgery, a renal biopsy was performed again due to proteinuria, and the results suggested ITG recurrence. The patient’s blood CD19-positive B-cell count was 0. Therefore, he was not administered rituximab again. Outcomes: The patient is now under regular review; his blood creatinine is relatively stable (120–150 mmol/L), while his 24-hour urine protein quantification is higher than the normal range. Lessons: This study expands the number of reported cases of this condition and will be useful to better understand the treatment options for patients with ITG recurrence after kidney transplantation.