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Acute tubular necrosis after renal allograft segmental infarction: the nephrotoxicity of necrotic material.

OBJECTIVES
Renal allograft dysfunction can be caused by renal vessel thrombosis, acute tubular necrosis, hyperacute or acute rejection, nephrotoxicity induced by cyclosporine or tacrolimus, thrombotic microangiopathy, or urinary tract obstruction.


MATERIALS AND METHODS
We describe a renal transplant recipient in whom oliguria developed during the first week after transplant, although his early renal allograft function was good.


RESULTS
A Doppler ultrasonographic study revealed a lack of perfusion in the lower pole of the allograft. A perfusion defect was noted in the lower pole that was supplied by a polar artery, which had been damaged during engraftment. Light microscopy disclosed tubular cell necrosis without evidence of vascular or humoral rejection.


CONCLUSIONS
We suggest that toxic molecules such as tumor necrosis factor-alpha released from a segmental infarcted area can induce tubular cell damage and necrosis leading to renal allograft dysfunction.