@article{3120910,
    title = "Antibody-mediated rejection with the presence of glomerular crescents in a pediatric kidney transplant recipient: A case report",
    author = "Karava, V. and Gakiopoulou, H. and Zampetoglou, A. and Marinaki, S. and Havaki, S. and Bitsori, M. and Stefanidis, C.J. and Mitsioni, A.",
    journal = "Pediatric Transplantation",
    year = "2020",
    volume = "24",
    number = "5",
    publisher = "Blackwell Publishing Inc.",
    issn = "1397-3142, 1399-3046",
    doi = "10.1111/petr.13722",
    keywords = "basiliximab;  complement component C4d;  creatinine;  HLA antigen class 1;  HLA antigen class 2;  immunoglobulin;  methylprednisolone;  mycophenolate mofetil;  prednisone;  rituximab;  tacrolimus, acute kidney failure;  Albanian (people);  Article;  atrophy;  capillaritis;  case report;  child;  chronic graft rejection;  clinical article;  congenital nephrotic syndrome;  creatinine blood level;  deceased donor;  disease severity;  end stage renal disease;  estimated glomerular filtration rate;  glomerulitis;  glomerulosclerosis;  graft recipient;  heterozygosity;  histology;  HLA matching;  human;  human tissue;  hyaline degeneration;  kidney biopsy;  kidney fibrosis;  kidney graft rejection;  kidney transplantation;  kidney tubule atrophy;  kidney tubule disorder;  low drug dose;  male;  nephrectomy;  peritoneal dialysis;  plasmapheresis;  prognosis;  proteinuria;  renal replacement therapy;  school child;  treatment response;  glomerulus;  graft rejection;  immunology;  pathology, Child;  Graft Rejection;  Humans;  Kidney Glomerulus;  Kidney Transplantation;  Male;  Prognosis",
    abstract = "Glomerular crescents in kidney transplantation are indicative of severe glomerular injury and constitute a hallmark of RPGN. Their concurrence with ABMR has been rarely described only in adult patients. We report a case of 10-year-old boy with compound heterozygous Fin-major Finnish-type congenital nephrotic syndrome, who had received a deceased-donor kidney transplant 5 years before onset of acute kidney injury and nephrotic range proteinuria without hematuria. Kidney allograft biopsy illustrated 6 glomeruli with global sclerosis and 6 with remarkable circumferential or segmental cellular crescents. Negative glomerular immunofluorescence for immune-complex deposits and the absence of serum ANCA eliminated the presence of immune-mediated and ANCA-positive pauci-immune crescentic glomerulonephritis. Diagnosis of ABMR was based on the high levels of HLA class II DSA and the histological evidence of glomerulitis, peritubular capillaritis, and acute tubular injury with positive linear peritubular capillary C4d staining. The patient despite plasmapheresis and enhanced immunosuppressive treatment progressed to end-stage renal disease. We conclude that glomerular crescents may represent a finding of AMBR and possibly a marker of poor allograft prognosis in pediatric patients. © 2020 Wiley Periodicals LLC"
}