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Diagnosis: Membranous glomerulonephritis, stage I (de novo post-trasplantation)

De novo membranous glomerulonephritis (MGN) is a significant complication after renal transplantation. Its etiology is still uncertain. Although in many cases of idiopathic MGN (in native kidneys) are found autoantibodies to phospholipase A2 receptor (PLA2R), in post-transplant MGN it does not seem to be frequent.

Recent works suggest that de novo post-transplant MGN has a distinct pathogenesis from idiopathic MGN. It is common to find donor-specific antibodies, peritubular capillaritis and C4d deposition in peritubular capillaries in cases of de novo MGN. These features suggest that MGN is mediated by another mechanism and hypothesize that it could be directly related to antibody-mediated rejection.

In an abstract published at the 11th Banff Conference, Paris, june 2011, Collins AB et al, consider that "The high frequency of C4d+ argues that de novo MGN is a form of chronic humoral rejection due to MHC or non-MHC antigens that affects PTC endothelium and glomerular podocytes". [Abstact 4 - Link].

The possibility that de novo post-transplantation MGN is caused by antibody-mediated rejection may raise other therapeutic options, but is not yet clear whether anti-humoral rejection therapy may be helpful.

See the chapter Membranous glomerulonephritis of our tutorial.

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References

• Honda K, Horita S, Toki D, Taneda S, Nitta K, Hattori M, Tanabe K, Teraoka S, Oda H, Yamaguchi Y. De novo membranous nephropathy and antibody-mediated rejection in transplanted kidney. Clin Transplant. 2011;25(2):191-200 [PubMed link]
• Debiec H, Martin L, Jouanneau C, Dautin G, Mesnard L, Rondeau E, Mousson C, Ronco P. Autoantibodies Specific for the Phospholipase A(2) Receptor in Recurrent and De Novo Membranous Nephropathy. Am J Transplant. 2011 Aug 9. [Epub ahead of print] [PubMed link]
• Collins AB, Satoskar AA, Beck LH, et al. De novo Membranous Glomerulonephritis (MGN) is immunologically distinct from idiopathic MGN and associated with C4d deposition and chronic humoral rejection. Presented at 11th Banff Conference on Allograft Pathology, June 6-10, 2011, Paris. Abstract 4 [Link: http://cybernephrology.ualberta.ca/banff/2011/submittedabstracts.htm]
• Aline-Fardin A, Rifle G, Martin L, Justrabo E, Bour JB, D'Athis P, Tanter Y, Mousson C. Recurent and de novo membranous glomerulopathy after kidney transplantation. Transplant Proc. 2009;41(2):669-71. [PubMed link]
• El Kossi M, Harmer A, Goodwin J, Wagner B, Shortland J, Angel C, McKane W. De novo membranous nephropathy associated with donor-specific alloantibody. Clin Transplant. 2008;22(1):124-7. [PubMed link]

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