{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,26]],"date-time":"2026-10-26T14:38:48Z","timestamp":1793025528009,"version":"4.5.0"},"reference-count":13,"publisher":"Wiley","issue":"S2","license":[{"start":{"date-parts":[[2015,6,2]],"date-time":"2015-06-02T00:00:00Z","timestamp":1433203200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Nephrology"],"published-print":{"date-parts":[[2015,7]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:p>Atypical hemolytic uremic syndrome (<jats:styled-content style=\"fixed-case\">aHUS<\/jats:styled-content>) in allograft kidney transplantation is caused by various factors including rejection, infection, and immunosuppressive drugs. We present a case of a 32 year old woman with <jats:styled-content style=\"fixed-case\">aHUS<\/jats:styled-content> four years after an <jats:styled-content style=\"fixed-case\">ABO<\/jats:styled-content>\u2010incompatible kidney transplantation from a living relative. The primary cause of end\u2010stage renal disease was unknown; however, <jats:styled-content style=\"fixed-case\">IgA<\/jats:styled-content> nephropathy (<jats:styled-content style=\"fixed-case\">IgAN<\/jats:styled-content>) was suspected from her clinical course. She underwent pre\u2010emptive kidney transplantation from her 60 year old mother. The allograft preserved good renal function [serum creatinine (<jats:styled-content style=\"fixed-case\">sCr<\/jats:styled-content>) level 110\u2013130\u2009\u03bcmol\/<jats:styled-content style=\"fixed-case\">L<\/jats:styled-content>] until a sudden attack of abdominal pain four years after transplant, with acute renal failure (<jats:styled-content style=\"fixed-case\">sCr<\/jats:styled-content> level, 385.3\u2009\u03bcmol\/<jats:styled-content style=\"fixed-case\">L<\/jats:styled-content>), decreasing platelet count, and hemolytic anemia with schizocytes. On allograft biopsy, there was thrombotic microangiopathy in the glomeruli, with a cellular crescent formation and mesangial <jats:styled-content style=\"fixed-case\">IgA<\/jats:styled-content> and <jats:styled-content style=\"fixed-case\">C<\/jats:styled-content>3 deposition. Microvascular inflammation, such as glomerulitis, peritubular capillaritis, and arteriole endarteritis were also detected. A disintegrin\u2010like and metalloproteinase with thrombospondin type 1 motifs 13 (<jats:styled-content style=\"fixed-case\">ADAMTS13<\/jats:styled-content>) did not decrease and <jats:styled-content style=\"fixed-case\">S<\/jats:styled-content>higa toxin was not detected. Donor\u2010specific antibodies or autoantibodies, including anti\u2010neutrophil cytoplasmic antibody and anti\u2010glomerular basement membrane (anti\u2010<jats:styled-content style=\"fixed-case\">GBM<\/jats:styled-content>) antibody, were negative. The patient was diagnosed with <jats:styled-content style=\"fixed-case\">aHUS<\/jats:styled-content> and received three sessions of plasmapheresis and methylprednisolone pulse therapy, followed by oral methylprednisolone (0.25\u20130.5\u2009mg\/kg) instead of tacrolimus. She temporarily required hemodialysis (<jats:styled-content style=\"fixed-case\">sCr<\/jats:styled-content> level, 658.3\u2009\u03bcmol\/<jats:styled-content style=\"fixed-case\">L<\/jats:styled-content>). Thereafter, her <jats:styled-content style=\"fixed-case\">sCr<\/jats:styled-content> level improved to 284.5\u2009\u03bcmol\/<jats:styled-content style=\"fixed-case\">L<\/jats:styled-content> without dialysis therapy. This case is clinically considered as <jats:styled-content style=\"fixed-case\">aHUS<\/jats:styled-content> after kidney transplantation, associated with various factors, including rejection, glomerulonephritis, and toxicity from drugs such as tacrolimus.<\/jats:p>","DOI":"10.1111\/nep.12465","type":"journal-article","created":{"date-parts":[[2015,6,2]],"date-time":"2015-06-02T23:42:53Z","timestamp":1433288573000},"page":"61-65","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Atypical hemolytic uremic syndrome diagnosed four years after <scp>ABO<\/scp>\u2010incompatible kidney transplantation"],"prefix":"10.1111","volume":"20","author":[{"given":"Keiko","family":"Kawaguchi","sequence":"first","affiliation":[{"name":"Department of Medicine Kidney Center Tokyo Women's Medical University  Tokyo Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kunio","family":"Kawanishi","sequence":"additional","affiliation":[{"name":"Department of Surgical Pathology Tokyo Women's Medical University  Tokyo Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Masayo","family":"Sato","sequence":"additional","affiliation":[{"name":"Department of Medicine Kidney Center Tokyo Women's Medical University  Tokyo Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mitsuyo","family":"Itabashi","sequence":"additional","affiliation":[{"name":"Department of Medicine Kidney Center Tokyo Women's Medical University  Tokyo Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Akiko","family":"Fujii","sequence":"additional","affiliation":[{"name":"Department of Surgical Pathology Tokyo Women's Medical University  Tokyo Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yukiko","family":"Kanetsuna","sequence":"additional","affiliation":[{"name":"Department of Surgical Pathology Tokyo Women's Medical University  Tokyo Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shouhei","family":"Huchinoue","sequence":"additional","affiliation":[{"name":"Department of Surgical Nephrology Tokyo Women's Medical University  Tokyo Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ryuji","family":"Ohashi","sequence":"additional","affiliation":[{"name":"Department of Surgical Pathology Nippon Medical School Hospital  Tokyo Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Junki","family":"Koike","sequence":"additional","affiliation":[{"name":"Department of Pathology Kawasaki Municipal Tama Hospital  Kawasaki Kanagawa 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