UpToDate
Official reprint from UpToDate®
www.uptodate.com ©2016 UpToDate®

Membranous nephropathy and renal transplantation

Authors
Jean Francis, MD
Laurence H Beck, Jr, MD, PhD
Section Editor
Daniel C Brennan, MD, FACP
Deputy Editor
Albert Q Lam, MD

INTRODUCTION

Membranous nephropathy (MN) may occur in the transplanted kidney, either as recurrent disease in patients who had MN as the cause of end-stage renal disease in the native kidney or de novo in patients who had another cause of end-stage renal disease initially. This topic reviews both recurrent and de novo MN in the transplanted kidney.

The causes, diagnosis, and treatment of MN in the native kidney are discussed elsewhere. (See "Causes and diagnosis of membranous nephropathy" and "Treatment of idiopathic membranous nephropathy".)

The recurrence of other glomerular diseases in the transplanted kidney is discussed elsewhere. (See "Focal segmental glomerulosclerosis in the transplanted kidney" and "Recurrence of idiopathic immune complex-mediated membranoproliferative glomerulonephritis (MPGN) after transplantation" and "IgA nephropathy: Recurrence after transplantation".)

RECURRENT MEMBRANOUS NEPHROPATHY

Epidemiology — The reported incidence of recurrent MN ranges between 10 and 45 percent [1-10]. The reason for the wide variability is that the diagnosis is made only by biopsy, and the indications for biopsy vary between transplant centers [11]. Centers that perform protocol biopsies in the absence of symptoms generally report a higher incidence. The best data are from one study of 19 patients with MN who underwent surveillance biopsies after transplantation, of which recurrent MN was detected in eight (42 percent) [8].

Initial reports suggested that patients with living, related transplants are at higher risk for recurrence than those who receive deceased-donor grafts [2,12]. However, this has not been confirmed by larger studies [8-10]. In one study of 35 patients with MN who received a kidney allograft between 1975 and 2008, 12 patients (34 percent) developed recurrent MN [10]. Although the rate of recurrence was modestly higher among patients who had a living, related transplant compared with those who received a deceased-donor allograft (4 of 8, or 50 percent, versus 8 of 27, or 30 percent, respectively), the difference was not significant. Two other series that included a total of 53 patients were also unable to confirm a higher risk associated with living, related transplantation [8,9].

                

Subscribers log in here

To continue reading this article, you must log in with your personal, hospital, or group practice subscription. For more information or to purchase a personal subscription, click below on the option that best describes you:
Literature review current through: Nov 2016. | This topic last updated: Wed Oct 12 00:00:00 GMT+00:00 2016.
The content on the UpToDate website is not intended nor recommended as a substitute for medical advice, diagnosis, or treatment. Always seek the advice of your own physician or other qualified health care professional regarding any medical questions or conditions. The use of this website is governed by the UpToDate Terms of Use ©2016 UpToDate, Inc.
References
Top
  1. Josephson MA, Spargo B, Hollandsworth D, Thistlethwaite JR. The recurrence of recurrent membranous glomerulopathy in a renal transplant recipient: case report and literature review. Am J Kidney Dis 1994; 24:873.
  2. Berger BE, Vincenti F, Biava C, et al. De novo and recurrent membranous glomerulopathy following kidney transplantation. Transplantation 1983; 35:315.
  3. Mathew TH. Recurrence of disease following renal transplantation. Am J Kidney Dis 1988; 12:85.
  4. Kotanko P, Pusey CD, Levy JB. Recurrent glomerulonephritis following renal transplantation. Transplantation 1997; 63:1045.
  5. Cosyns JP, Couchoud C, Pouteil-Noble C, et al. Recurrence of membranous nephropathy after renal transplantation: probability, outcome and risk factors. Clin Nephrol 1998; 50:144.
  6. Floege J. Recurrent glomerulonephritis following renal transplantation: an update. Nephrol Dial Transplant 2003; 18:1260.
  7. Choy BY, Chan TM, Lai KN. Recurrent glomerulonephritis after kidney transplantation. Am J Transplant 2006; 6:2535.
  8. Dabade TS, Grande JP, Norby SM, et al. Recurrent idiopathic membranous nephropathy after kidney transplantation: a surveillance biopsy study. Am J Transplant 2008; 8:1318.
  9. Sprangers B, Lefkowitz GI, Cohen SD, et al. Beneficial effect of rituximab in the treatment of recurrent idiopathic membranous nephropathy after kidney transplantation. Clin J Am Soc Nephrol 2010; 5:790.
  10. Moroni G, Gallelli B, Quaglini S, et al. Long-term outcome of renal transplantation in patients with idiopathic membranous glomerulonephritis (MN). Nephrol Dial Transplant 2010; 25:3408.
  11. Ponticelli C, Glassock RJ. Posttransplant recurrence of primary glomerulonephritis. Clin J Am Soc Nephrol 2010; 5:2363.
  12. Obermiller LE, Hoy WE, Eversole M, Sterling WA. Recurrent membranous glomerulonephritis in two renal transplants. Transplantation 1985; 40:100.
  13. Beck LH Jr, Bonegio RG, Lambeau G, et al. M-type phospholipase A2 receptor as target antigen in idiopathic membranous nephropathy. N Engl J Med 2009; 361:11.
  14. Stahl R, Hoxha E, Fechner K. PLA2R autoantibodies and recurrent membranous nephropathy after transplantation. N Engl J Med 2010; 363:496.
  15. Debiec H, Martin L, Jouanneau C, et al. Autoantibodies specific for the phospholipase A2 receptor in recurrent and De Novo membranous nephropathy. Am J Transplant 2011; 11:2144.
  16. Blosser CD, Ayalon R, Nair R, et al. Very early recurrence of anti-Phospholipase A2 receptor-positive membranous nephropathy after transplantation. Am J Transplant 2012; 12:1637.
  17. Debiec H, Hanoy M, Francois A, et al. Recurrent membranous nephropathy in an allograft caused by IgG3κ targeting the PLA2 receptor. J Am Soc Nephrol 2012; 23:1949.
  18. Beck LH Jr. Monoclonal anti-PLA2R and recurrent membranous nephropathy: another piece of the puzzle. J Am Soc Nephrol 2012; 23:1911.
  19. Gupta G, Fattah H, Ayalon R, et al. Pre-transplant phospholipase A2 receptor autoantibody concentration is associated with clinically significant recurrence of membranous nephropathy post-kidney transplantation. Clin Transplant 2016; 30:461.
  20. Grupper A, Cornell LD, Fervenza FC, et al. Recurrent Membranous Nephropathy After Kidney Transplantation: Treatment and Long-Term Implications. Transplantation 2015.
  21. Kattah A, Ayalon R, Beck LH Jr, et al. Anti-phospholipase A₂ receptor antibodies in recurrent membranous nephropathy. Am J Transplant 2015; 15:1349.
  22. Quintana LF, Blasco M, Seras M, et al. Antiphospholipase A2 Receptor Antibody Levels Predict the Risk of Posttransplantation Recurrence of Membranous Nephropathy. Transplantation 2015; 99:1709.
  23. Seitz-Polski B, Payré C, Ambrosetti D, et al. Prediction of membranous nephropathy recurrence after transplantation by monitoring of anti-PLA2R1 (M-type phospholipase A2 receptor) autoantibodies: a case series of 15 patients. Nephrol Dial Transplant 2014; 29:2334.
  24. Tomas NM, Beck LH Jr, Meyer-Schwesinger C, et al. Thrombospondin type-1 domain-containing 7A in idiopathic membranous nephropathy. N Engl J Med 2014; 371:2277.
  25. Prunotto M, Carnevali ML, Candiano G, et al. Autoimmunity in membranous nephropathy targets aldose reductase and SOD2. J Am Soc Nephrol 2010; 21:507.
  26. El-Zoghby ZM, Grande JP, Fraile MG, et al. Recurrent idiopathic membranous nephropathy: early diagnosis by protocol biopsies and treatment with anti-CD20 monoclonal antibodies. Am J Transplant 2009; 9:2800.
  27. Larsen CP, Walker PD. Phospholipase A2 receptor (PLA2R) staining is useful in the determination of de novo versus recurrent membranous glomerulopathy. Transplantation 2013; 95:1259.
  28. Kearney N, Podolak J, Matsumura L, et al. Patterns of IgG subclass deposits in membranous glomerulonephritis in renal allografts. Transplant Proc 2011; 43:3743.
  29. Kattah AG, Alexander MP, Angioi A, et al. Temporal IgG Subtype Changes in Recurrent Idiopathic Membranous Nephropathy. Am J Transplant 2016; 16:2964.
  30. Montagnino G, Colturi C, Banfi G, et al. Membranous nephropathy in cyclosporine-treated renal transplant recipients. Transplantation 1989; 47:725.
  31. Briganti EM, Russ GR, McNeil JJ, et al. Risk of renal allograft loss from recurrent glomerulonephritis. N Engl J Med 2002; 347:103.
  32. El-Zoghby ZM, Stegall MD, Lager DJ, et al. Identifying specific causes of kidney allograft loss. Am J Transplant 2009; 9:527.
  33. Rodriguez EF, Cosio FG, Nasr SH, et al. The pathology and clinical features of early recurrent membranous glomerulonephritis. Am J Transplant 2012; 12:1029.
  34. Truong L, Gelfand J, D'Agati V, et al. De novo membranous glomerulonephropathy in renal allografts: a report of ten cases and review of the literature. Am J Kidney Dis 1989; 14:131.
  35. Gallon L, Chhabra D. Anti-CD20 monoclonal antibody (rituximab) for the treatment of recurrent idiopathic membranous nephropathy in a renal transplant patient. Am J Transplant 2006; 6:3017.
  36. Weclawiak H, Ribes D, Guilbeau-Frugier C, et al. Relapse of membranous glomerulopathy after kidney transplantation: sustained remittance induced by rituximab. Clin Nephrol 2008; 69:373.
  37. Sirimongkolrat T, Premasathian N, Vongwiwatana A, et al. Anti-CD20 monoclonal antibody (rituximab) for the treatment of membranous nephropathy after living-unrelated kidney transplantation: a case report. Transplant Proc 2008; 40:2440.
  38. Cravedi P, Ruggenenti P, Remuzzi G. Low-dose rituximab for posttransplant recurrent membranous nephropathy. Am J Transplant 2010; 10:1336.
  39. Carson KR, Evens AM, Richey EA, et al. Progressive multifocal leukoencephalopathy after rituximab therapy in HIV-negative patients: a report of 57 cases from the Research on Adverse Drug Events and Reports project. Blood 2009; 113:4834.
  40. Toki D, Ishida H, Horita S, et al. Impact of low-dose rituximab on splenic B cells in ABO-incompatible renal transplant recipients. Transpl Int 2009; 22:447.
  41. Shirakawa H, Ishida H, Shimizu T, et al. The low dose of rituximab in ABO-incompatible kidney transplantation without a splenectomy: a single-center experience. Clin Transplant 2011; 25:878.
  42. Vieira CA, Agarwal A, Book BK, et al. Rituximab for reduction of anti-HLA antibodies in patients awaiting renal transplantation: 1. Safety, pharmacodynamics, and pharmacokinetics. Transplantation 2004; 77:542.
  43. Spinner ML, Bowman LJ, Horwedel TA, et al. Single-dose rituximab for recurrent glomerulonephritis post-renal transplant. Am J Nephrol 2015; 41:37.
  44. Fervenza FC, Cosio FG, Erickson SB, et al. Rituximab treatment of idiopathic membranous nephropathy. Kidney Int 2008; 73:117.
  45. Fervenza FC, Abraham RS, Erickson SB, et al. Rituximab therapy in idiopathic membranous nephropathy: a 2-year study. Clin J Am Soc Nephrol 2010; 5:2188.
  46. Heidet L, Gagnadoux ME, Beziau A, et al. Recurrence of de novo membranous glomerulonephritis on renal grafts. Clin Nephrol 1994; 41:314.
  47. Schwarz A, Krause PH, Offermann G, Keller F. Impact of de novo membranous glomerulonephritis on the clinical course after kidney transplantation. Transplantation 1994; 58:650.
  48. Honda K, Horita S, Toki D, et al. De novo membranous nephropathy and antibody-mediated rejection in transplanted kidney. Clin Transplant 2011; 25:191.
  49. Robles NR, Gomez-Campdera F, Anaya F, et al. Membranous glomerulonephritis after kidney transplantation and urologic complications. Am J Nephrol 1992; 12:279.
  50. El Kossi M, Harmer A, Goodwin J, et al. De novo membranous nephropathy associated with donor-specific alloantibody. Clin Transplant 2008; 22:124.