Membranous nephropathy and renal transplantation
- Jean Francis, MD
Jean Francis, MD
- Assistant Professor of Medicine
- Boston University School of Medicine
- Laurence H Beck, Jr, MD, PhD
Laurence H Beck, Jr, MD, PhD
- Associate Professor of Medicine
- Boston University School of Medicine
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 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 . 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) .
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 . 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].
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- RECURRENT MEMBRANOUS NEPHROPATHY
- Clinical presentation
- - Mild disease
- - Moderate to severe disease
- Rituximab resistant
- DE NOVO MEMBRANOUS NEPHROPATHY
- Clinical manifestations
- SUMMARY AND RECOMMENDATIONS