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Diagnosis:
Recurrent Membranous glomerulonephritis
The frequency of recurrence of membranous glomerulonephritis (MGN) is about 25% to 42% within 3 years. Recurrent MGN can appear within the first post-transplantation weeks with variable levels of proteinuria. The diagnostic criteria for recurrent MGN are the domonstration of MGN in the native kidneys and an initial normal biopsy to exclude MGN in the donor.
Since renal allograft recipients are monitored closely, proteinuria is typically detected early. In these cases light microscopic studies (including methenamine-silver stain) usually do not demonstrate diagnostic abnormalities, which are detected only by immunofluorescence or electron microscopy: subepithelial immune deposits without GBM spike formation: MGN stage I.
Only a few (less than 10%) of all cases of MGN in allografts arise as recurrence in patients with a previous history of MGN. The cause of recurrent MGN is unknown and no conclusive risk factors have been identified.
Although some authors report that the overall outcome is not greatly affected by the presence of recurrent MGN, in our center we have seen cases with severe nephrotic syndrome and accelerated impairement of renal function. Graft loss has been reported in about 10% to 50% of patients with recurrence within 10 years (Colvin RB, Nickeleit V. Renal Transplant Pathology. In: Jennette JC et al. (Eds). Heptinstall's Pathology of the Kidney, 6th edition, Philadelphia, Wolters Kluwer - Lippincott Williams and Wilkins, 2007, p. 1455).
See the chapter Membranous Glomerulonephritis of our Tutorial, with atlas and text (English version).
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References
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Dabade TS, Grande JP, Norby SM, Fervenza FC, Cosio FG. Recurrent idiopathic membranous nephropathy after kidney transplantation: a surveillance biopsy study. Am J Transplant. 2008;8(6):1318-22. [PubMed link]
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Poduval RD, Josephson MA, Javaid B. Treatment of de novo and recurrent membranous nephropathy in renal transplant patients. Semin Nephrol. 200l;23(4):392-9. [PubMed link]
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Cosyns JP, Couchoud C, Pouteil-Noble C, Squifflet JP, Pirson Y. Recurrence of membranous nephropathy after renal transplantation: probability, outcome and risk factors. Clin Nephrol. 1998;50(3):144-53. [PubMed link]
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Marcen R, Mampaso F, Teruel JL, Rivera ME, Orofino L, Navarro-Antolin J, Ortuño J. Membranous nephropathy: recurrence after kidney transplantation. Nephrol Dial Transplant. 1996;11(6):1129-33. [PubMed link] [Free full text]
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Couchoud C, Pouteil-Noble C, Colon S, Touraine JL. Recurrence of membranous nephropathy after renal transplantation. Incidence and risk factors in 1614 patients. Transplantation. 1995 ;59(9):1275-9. [PubMed link]
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Schwarz A, Krause PH, Offermann G, Keller F. Impact of de novo membranous glomerulonephritis on the clinical course after kidney transplantation. Transplantation. 1994;58(6):650-4. [PubMed link]