No abstract

renal disease in almost 5% of patients, in whom treatment modality of choice is renal transplantation. Among patients undergoing a transplant for PMN, 30-50% will experience the disease recurrence and among them graft loss will occur in about 50% within 10 years. Currently there are no evidence based recommended guidelines for management of recurrent PMN in post renal transplant period. The purpose of this article is to describe the evolving role of anti-phospholipase A2 receptor auto-antibodies (aPLA2R) as a bio marker in recurrent PMN and its usefulness in predicting the recurrence and outcome and to explain the emerging role of rituximab in management of recurrent PMN in post renal transplantation. Methods: This article would be based on the published research work by the different authors. Results: The discovery of aPLA2R has changed the whole dimension of recurrent PMN management. Several studies have suggested that aPLA2R levels are clinically relevant to assess the risk of recurrence and disease progression, to guide the treatment indication and to monitor treatment response in recurrent PMN in post kidney transplant period. Use of aPLA2R in early detection of recurrent PMN in post kidney transplantation has opened a new door in managing these complex patients. Currently, there are no evidence-based guidelines supporting treatment strategies to prevent or treat recurrent PMN. The traditional regimens for PMN in native kidney are of little or no benefit in post kidney transplant recurrent PMN. Rituximab, a chimeric anti-CD20 monoclonal antibody (mAb) has emerged as a promising therapeutic option for such patients. It has proved to be an effective and valuable treatment in all patients in stabilizing proteinuria and renal functions. Another possible advantages of this treatment beside large number of patients achieving partial or complete remission is that it is not necessary to modify the post-transplant maintenance immunosuppressive therapy. Conclusions: In conclusion, an approach intending an early diagnosis by utilizing PLA2R titers and early treatment using rituximab will help in reducing the risk of kidney graft loss secondary to recurrent PMN.