A primer on recurrent and de novo glomerulonephritis in renal allografts

Iványi, Béla

doi:10.1038/ncpneph0854

Cited by 72 publications

(39 citation statements)

References 75 publications

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“…The use of immunosuppressive drugs enhances viral replication, leading to acceleration of liver injury and progression to hepatocellular failure (1). Moreover, HBV-associated GN may recur or develop de novo in the graft, reducing function or even ultimately inducing graft failure (2,3).…”

Section: Introductionmentioning

confidence: 99%

Impact of Pre-Existing Hepatitis B Infection on the Outcomes of Kidney Transplant Recipients in the United States

Reddy

Sampaio

Kuo

et al. 2011

Clinical Journal of the American Society of Nephrology

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SummaryBackground and objectives Pre-existing hepatitis B virus (HBV) infection has been associated in inferior renal transplant outcomes. We examined outcomes of HBVϩ renal recipients in a more recent era with availability of oral anti-viral agents.Design, setting, participants, & measurements Using the Organ Procurement Transplant Network/United Network for Organ Sharing database, we selected adult primary kidney recipients transplanted in the United States (2001 to 2007). The cohort was divided into HBVϩ (surface antigen positive, n ϭ 1346) and HBVϪ patients (surface antigen negative; n ϭ 74,335). Five-year graft survival, patient survival, hepatic failure incidence, and associated adjusted risks were compared.Results HBVϩ recipients were more frequently Asian, had a lower body mass index, and glomerulonephritis was more prevalent as the etiology of ESRD. HBVϩ recipients had less pretransplant diabetes and cardiovascular disease, were less likely a living donor recipient, and were less likely to receive steroids at discharge. Five-year patient survival was 85.3% and 85.6% and graft survival was 74.9% and 75.1% for HBVϩ and HBVϪ, respectively. HBV infection was not a risk factor for death or kidney failure, although 5-year cumulative incidence of hepatic failure was higher in HBVϩ recipients (1.3% versus 0.2%; P Ͻ 0.001), and HBVϩ was associated with 5.5-and 5.2-fold increased risk for hepatic failure in living and deceased donors, respectively, compared with HBVϪ. ConclusionsIn a recent era (2001 to 2007), HBV-infected renal recipients were not at higher risk for kidney failure or death; however, they remain at higher risk of liver failure compared with HBVϪ recipients.

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Section: Introductionmentioning

confidence: 99%

Impact of Pre-Existing Hepatitis B Infection on the Outcomes of Kidney Transplant Recipients in the United States

Reddy

Sampaio

Kuo

et al. 2011

Clinical Journal of the American Society of Nephrology

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“…Still, too many patients proceed to transplant without a formal diagnosis of their kidney disease, thus limiting the opportunity to improve our knowledge about potentially recurrent diseases and the chance to better treat recipients at risk of recurrence. 5,10,11 Early referral to a nephrologist and prompt histologic evaluation of the kidney are key factors and should be strongly promoted by the transplant community.…”

Section: Discussionmentioning

confidence: 99%

Untitled

Favi

Pedroso²,

Salerno³

et al. 2018

Exp Clin Transplant

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Objectives: Recurrent glomerulonephritis can negatively affect kidney allograft survival. However, how primary renal disease affects transplant outcomes in the new era of immunosuppression remains unclear. Materials and Methods: We categorized 426 kidney transplant recipients (performed from 1996 to 2007) into 4 disease groups: (1) 99 recipients with biopsyproven immunologically mediated kidney disease, (2) 40 recipients with urologic disease, (3) 67 recipients with polycystic kidney disease, and (4) 220 recipients with other causes of terminal renal failure/uncertain kidney disease. Long-term transplant outcomes were compared between groups at 1, 5, and 10 years of follow-up. Results: Compared with the urologic, polycystic, and other diseases groups, the immunologic group showed significantly lower time of graft survival (9.5 ± 4 vs 8 ± 4 vs 8.5 ± 4 vs 7 ± 4 years, respectively) and estimated glomerular filtration rate (52.5 ± 32 vs 49 ± 22 vs 50 ± 32 vs 35.5 ± 30 mL/min; P < .05). Relative risk of 10-year graft loss for the immunologic group was 2.8 (95% confidence interval, 1.6-4.9). Recurrence rate was 12% in the immunologic group versus 1% and 0% in the other diseases and remaining groups (P < .05). The relative risk of 10-year graft loss for patients with recurrence was 2.7 (95% confidence interval, 1.2-6.3). Ten-year graft loss rates for patients with biopsy-proven acute rejection, chronic allograft nephropathy, and recurrent glomerulonephritis were 30%, 23%, and 42% (P < .05). For those with biopsyproven recurrent glomerulonephritis, 10-year estimated glomerular filtration rate was significantly lower than for those with biopsy-proven acute rejection or chronic allograft nephropathy (14 ± 6 vs 18 ± 7 vs 30 ± 10 mL/min; P < .05). Conclusions: Kidney transplant recipients with immunologically mediated kidney diseases have inferior long-term allograft survival and function versus patients with other causes of renal failure. Recurrence represents the strongest risk factor for premature loss of function and transplant failure.

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“…Answers from the membership, question 6B. during a mean follow-up of 57 months, and 24% of patients exhibited nephrotic syndrome at the time of diagnosis (71). Virtually 100% of patients with type 2 diabetes will develop recurrence of diabetic nephropathy in the kidney transplant with an average time to onset of de novo diabetic nephropathy of 10 years (72).…”

Section: Discussion Of Case 6 (Question 6b)mentioning

confidence: 99%

Nephrology Quiz and Questionnaire

Glassock

Bargman²,

Palmer³

et al. 2010

Clinical Journal of the American Society of Nephrology

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T he Nephrology Quiz and Questionnaire returns to the pages of CJASN after an absence of 3 years, but it still remains one of the most popular sessions at the annual meeting of the American Society of Nephrology. The meeting in 2009 in San Diego was no exception, with a full-house attendance, estimated at more than 800 eager nephrologists. Eight challenging and educational cases were presented and discussed by four able and skilled experts. The discussants were asked to prepare vignettes of puzzling cases, each illustrating some topical, challenging, or controversial aspect of diagnosis or management of ESRD and dialysis (Dr. Bargman), fluid and electrolytes (Dr. Palmer), kidney transplantation (Dr. Samaniego), and glomerular disease (Dr. Fervenza). One or two single best answers questions followed each case presentation, which were addressed by the audience in a live electronic response system. In addition, several weeks before the meeting, the cases and questions (without the answers) were sent to all of the US nephrology training program directors as a questionnaire. Their responses to the questions were tallied and presented after the audience response but before the answers to the quiz and the analyses of the cases were given by the discussants.Each discussant prepared a manuscript summarizing his or her discussion of the cases, an edited version of which serves as the main text of this article. We hope that this "distillate" from San Diego will serve the subscribers to CJASN well and provide some fresh insights into the complexity and vibrancy of clinical nephrology for those who were unable to attend (Richard J. Glassock, MD, Moderator).

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A primer on recurrent and de novo glomerulonephritis in renal allografts

Cited by 72 publications

References 75 publications

Impact of Pre-Existing Hepatitis B Infection on the Outcomes of Kidney Transplant Recipients in the United States

Impact of Pre-Existing Hepatitis B Infection on the Outcomes of Kidney Transplant Recipients in the United States

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