Nephropathology
   
Case 127
Diagnosis
 
     
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Diagnosis: Lupus Nephritis Recurrence

The presence of fuschinofilic subendothelial deposits (Figures 6 and 7) and subendothelial segmental deposits of immune complexes (IgA and IgG) with C3 and C1q, suggested lupus recurrence. C3 serum level was 54 mg/dL (90-180) and C4 9,2 (10-40). ANA and anti-DNA were positive. There was not detected extrarenal manifestations.

The frequency and outcome of recurrent lupus nephritis (RLN) among recipients of a kidney allograft vary among single-center reports. From the United Network for Organ Sharing files, the prevalence of RLN was 2.4%. Severe RLN is uncommon in recipients of a kidney allograft, but black recipients, female recipient, and younger recipients are at increased risk (Contreras G, et al.Recurrence of lupus nephritis after kidney transplantation. J Am Soc Nephrol. 2010;21:1200-7. [PubMed link]).

Histologic recurrence is frequent in lupus nephritis, but the lesions are rarely severe and usually do not impair the long-term graft outcome (Ponticelli C, et al. Recurrence of secondary glomerular disease after renal transplantation. Clin J Am Soc Nephrol. 2011;6:1214-21. [PubMed link]).

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References

  • Çeltİk A, Şen S, Tamer AF, Yılmaz M, Sarsık B, Özkahya M, Başçı A, Töz H. Recurrent lupus nephritis after transplantation: Clinicopathological evaluation with protocol biopsies. Nephrology (Carlton). 2016;21(7):601-7. [PubMed link]
  • Lionaki S, Skalioti C, Boletis JN. Kidney transplantation in patients with systemic lupus erythematosus. World J Transplant. 2014;4(3):176-82. [PubMed link]
  • Moon SJ, Park HS, Kwok SK, Ju JH, Kim HY, Park SH. Predictors of end-stage renal disease and recurrence of lupus activity after initiation of dialysis in patients with lupus nephritis. Clin Exp Rheumatol. 2013;31(1):31-9. [PubMed link]
  • Ponticelli C, Moroni G, Glassock RJ. Recurrence of secondary glomerular disease after renal transplantation. Clin J Am Soc Nephrol. 2011;6(5):1214-21. [PubMed link]
  • Contreras G, Mattiazzi A, Guerra G, Ortega LM, Tozman EC, Li H, Tamariz L, Carvalho C, Kupin W, Ladino M, LeClercq B, Jaraba I, Carvalho D, Carles E, Roth D. Recurrence of lupus nephritis after kidney transplantation. J Am Soc Nephrol. 2010;21(7):1200-7. [PubMed link]
  • Norby GE, Strøm EH, Midtvedt K, Hartmann A, Gilboe IM, Leivestad T, Stenstrøm J, Holdaas H. Recurrent lupus nephritis after kidney transplantation: a surveillance biopsy study. Ann Rheum Dis. 2010;69(8):1484-7. [PubMed link]

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