The child had slowly progressive chronic renal failure, with arterial hypertension well-controlled by poly-antihypertensive treatment and metabolic acidosis needing bicarbonate supplementation. At the age of 6, the child reached ESRF and began a regular hemodialysis treatment.
His mother agreed to be a living donor and the child had a successful kidney transplantation a few months later, after bilateral nephrectomy performed to make room for the mother’s kidney.
It was 1995, and the child was put in therapy with cyclosporine, steroids and azathioprine, with good success.
One year after transplantation, the child presented with a progressively worsening thrombocytopenia without neutropenia or anemia. He was in full treatment with EPO and his hemoglobin level was 11.5 mg/dl. He had no fever, no enlarged lymphonodes were detectable, liver function tests were normal. Bone marrow aspiration showed hyperplasia of each cell series, with a particularly high presence of megacariocytes. He complained frequently of abdominal pain. Abdominal US detected normal grafted kidney and hyperechogenic liver.

Question 6