Kidney Transplantation: Challenging the Future

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Kidney transplantation is worldwide considered the best replacement therapy in patients with end-stage renal disease. However, although impressive improvements in surgical techniques and in the ...
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Glomerulonephritis After Kidney Transplantation

Pp. 324-339 (16)

DOI: 10.2174/978160805144111201010324

Author(s): Bela Ivanyi, Dejan Dobi, Eva Kemeny, Edit Szederkenyi

Abstract

The prevalence, impact and main clinicopathological aspects of recurrent and de novo glomerulonephritis are reviewed, with the use of unpublished data of the authors. The prevalence in Hungarian recipients was investigated in 697 biopsies obtained for cause and analyzed by light microscopy and an expanded panel of immunofluorescence. Electron microscopy was performed if there were symptoms of glomerular disease or the histological alterations or immunfluorescent findings indicated. Glomerular disease was recorded in 199 biopsies (28.5%): chronic rejection-induced transplant glomerulopathy in 155 biopsies (22.2%), post-transplantation glomerulonephritis (recurrent, de novo or undetermined) in 39 (5.5%) biopsies, and systemic disease affecting the glomeruli in 8 biopsies (1.1%). Membranous nephropathy (17), IgA nephritis (9), focal-segmental glomerulosclerosis (8), mesangial proliferative glomerulonephritis, (3) IgM nephropathy (1) and type I membranoproliferative glomerulonephritis (1) were identified. Transplant glomerulopathy frequently coincided with membranous nephropathy. Unusual combinations of histological patterns and/or immunofluorescent findings were occasionally observed, such as mesangial proliferation with mesangial and peripheral immune deposits, or epimembranous and mesangial deposits, or mesangial proliferation and subperimesangial deposits of solely IgM. Post-transplantation GN, more frequent in males, unfavorably influenced graft survival. Our results and the literature data indicate that posttransplantation glomerulonephritis relatively rarely involves the white race. Male gender, non-white ethnicity, younger age and biopsy-proven glomerulonephritis in the native kidney are predictors of posttransplantation glomerulonephritis. Post-transplantation glomerulonephritis contributes significantly to late allograft loss; through elevated serum creatinine levels and proteinuria, it precipitates the cardiovascular mortality and morbidity of the recipient. Limited evidence is available on the management of post-transplantation glomerulonephritis.

Keywords:

De novo Glomerulonephritis, Epidemiology, Kidney Transplant, Recurrent Glomerulonephritis, Plasmapheresis, Rituximab, Steroids, Immunosuppression, Kidney Biopsy, Membranous Nephropathy.