Recurent and De Novo Membranous Glomerulopathy After Kidney Transplantation

Aline-Fardin, Aude; Rifle, G; Martin, Laurent; Justrabo, E; Bour, Jean-Baptiste; d'Athis, P.; Tanter, Y.; Mousson, Christiane

doi:10.1016/j.transproceed.2009.01.042

Cited by 19 publications

(9 citation statements)

References 15 publications

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“…In a collaborative French study, 19 cases of de novo MN were detected in a series of 1000 kidney graft biopsies [5]. A similar percentage (1.8%) was also reported in another French study [6]. In a German series, de novo MN was diagnosed in 14 of 611 (2.3%) transplant recipients [7] and in the United Kingdom, de novo MN represented the second most frequent cause of nephrotic syndrome observed after kidney transplantation [8].…”

supporting

confidence: 61%

De novomembranous nephropathy (MN) in kidney allografts. A peculiar form of alloimmune disease?

Ponticelli¹,

Glassock²

2012

Transplant International

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Summary De novo membranous nephropathy (MN) is an uncommon complication of kidney transplantation, which shows histological findings similar to those seen in recurrent MN, but with some distinct differences. The clinical presentation may be variable, from asymptomatic to nephrotic proteinuria. The disease may run an indolent course or may have an accelerated course leading to allograft loss. De novo membranous nephropathy (MN) can develop in transplant recipients with viral hepatitis, Alport syndrome, ureteral obstruction, renal infarction, or in conjunction with recurrent IgA nephritis. Histologic signs of allograft rejection are often associated with or can antedate de novo MN. These findings suggest that donor‐specific antibodies and antibody‐mediated rejection might play a pathogenetic role in some patients with de novo MN. However, signs of rejection were absent in a number of cases, and in some instances the disease developed in recipients of “full house” HLA‐ matched kidneys. Thus, it seems possible that de novo MN is not because of allograft rejection per se, but is triggered by different injuries that can create an inflammatory environment, activate innate immunity, and expose hidden (cryptic) antigens, probably different from those observed to be involved in idiopathic MN. These events can lead to the production of circulating antibodies and in situ formation of immune complexes (IC) and the morphological lesion of MN.

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supporting

confidence: 61%

De novomembranous nephropathy (MN) in kidney allografts. A peculiar form of alloimmune disease?

Ponticelli¹,

Glassock²

2012

Transplant International

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“…In a recent study with protocol biopsies performed in 614 recipients transplanted between 1989 and 2006, 17 MNs were diagnosed in 15 patients (2.45% of the whole group), including 6 recurrent (35%) and 11 de novo MN (65%; Ref. 9). Recurrent MN occurred earlier than de novo MN (15.6 ± 19.1 months vs. 49.3 ± 32.7 months).…”

Section: Introductionmentioning

confidence: 99%

Autoantibodies Specific for the Phospholipase A2 Receptor in Recurrent and De Novo Membranous Nephropathy

Dębiec

Martin

Jouanneau

et al. 2011

American Journal of Transplantation

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127

102

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†These authors contributed equally in this study.Recent findings in idiopathic membranous nephropathy (MN) suggest that in most patients, the disease is because of anti-phospholipase A 2 receptor (PLA 2 R1) autoantibodies. Our aim was to analyze the prevalence and significance of anti-PLA 2 R1 antibodies in recurrent and de novo MN after transplantation. We assessed circulating PLA 2 R1 autoantibodies by a direct immunofluorescence assay based on human embryonic kidney cells transfected with a PLA 2 R1 cDNA, and the presence of PLA 2 R1 antigen in immune deposits. We showed that PLA 2 R1 was involved in 5 of 10 patients with recurrent MN, but in none of the 9 patients with de novo MN. We also showed a marked heterogeneity in the kinetics and titers of anti-PLA 2 R1, which may relate to different pathogenic potential. We provide evidence that some patients with PLA 2 R1-related idiopathic MN and anti-PLA 2 R1 antibodies at the time of transplantation will not develop recurrence. Because PLA 2 R1 autoantibody was not always associated with recurrence, its predictive value should be carefully analyzed in prospective studies.

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“…De novo membranous glomerulonephritis has features similar to the disease in native kidneys, but shows a stronger association with hepatitis C virus infection 73. De novo focal segmental glomerulosclerosis, including the collapsing variant does occur, but is more often secondary to chronic CNI toxicity, vascular disease, nephron loss or transplant glomerulopathy 74.…”

Section: Allograft Dysfunction and The Allograft Biopsymentioning

confidence: 99%

Our approach to a renal transplant biopsy

Herzenberg¹

2009

J Clin Pathol

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Kidney transplantation has become increasingly common in major health centres, making renal allograft evaluation through biopsy a common procedure. Early allograft dysfunction occurs in 30-50% of all transplants, while chronic graft failure is almost uniform at a rate of 2-4% a year. Allograft biopsy remains the gold standard for the diagnosis of graft dysfunction. Rejection, albeit the most important, is only one of many causes of allograft dysfunction. The widely accepted Banff classification has set criteria for the diagnosis of acute and chronic rejection. The major differential diagnoses are acute ischaemic injury, calcineurin inhibitor toxicity (acute and chronic), infections, including pyelonephritis and polyomavirus nephropathy, chronic obstruction/reflux, hypertension, and recurrent and de novo disease. In this review, there is an outline of the Banff criteria and their implications, the various causes of graft dysfunction, and a discussion on morphological guidelines towards the various diagnoses.

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Recurent and De Novo Membranous Glomerulopathy After Kidney Transplantation

Cited by 19 publications

References 15 publications

De novomembranous nephropathy (MN) in kidney allografts. A peculiar form of alloimmune disease?

De novomembranous nephropathy (MN) in kidney allografts. A peculiar form of alloimmune disease?

Autoantibodies Specific for the Phospholipase A2 Receptor in Recurrent and De Novo Membranous Nephropathy

Our approach to a renal transplant biopsy

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