Recurrence of idiopathic immune complex-mediated membranoproliferative glomerulonephritis (MPGN) after transplantation
- Anuja Java, MD
Anuja Java, MD
- Instructor in Medicine
- Washington University School of Medicine
- Daniel C Brennan, MD, FACP
Daniel C Brennan, MD, FACP
- Editor-in-Chief — Nephrology
- Section Editor — Renal Transplantation
- Professor of Medicine
- Medical Director and Co-Director of the Comprehensive Transplant Center, Department of Internal Medicine, Division of Nephrology
- Johns Hopkins Medical School
Membranoproliferative glomerulonephritis (MPGN, also called mesangiocapillary or lobular glomerulonephritis) is a disease defined by a pattern of glomerular injury observed by light microscopy on renal biopsy. An MPGN pattern of injury may result from multiple causes including infection, autoimmune diseases, monoclonal gammopathies, and complement dysregulation. In addition, an MPGN pattern of injury may occur in the absence of an obvious cause. This is referred to as idiopathic MPGN.
Patients with MPGN may progress to end-stage renal disease (ESRD) and require renal replacement therapy, including dialysis and/or transplantation. Among patients who undergo transplantation, idiopathic MPGN and MPGN resulting from complement dysregulation commonly recur. Patients with MPGN that is secondary to infection, autoimmune disorders, and monoclonal gammopathies are generally not eligible for transplantation, unless the underlying cause is addressed.
This topic reviews recurrent idiopathic MPGN in the transplanted kidney. The recurrence in the transplanted kidney of MPGN resulting from complement dysregulation is discussed elsewhere. (See "Recurrence of C3 glomerulopathies after transplantation".)
The presentation, classification, causes, and treatment of MPGN in the native kidney are discussed elsewhere. (See "Clinical presentation, classification, and causes of membranoproliferative glomerulonephritis" and "Evaluation and treatment of membranoproliferative glomerulonephritis" and "C3 glomerulopathies: Dense deposit disease and C3 glomerulonephritis".)
CLASSIFICATION AND PATHOGENESIS
MPGN is classified into subtypes, including immune complex-mediated MPGN and C3 glomerulopathy. Immune complex-mediated MPGN is characterized by both immunoglobulin and complement protein deposition in the kidney, as identified by immunofluorescence microscopy. C3 glomerulopathy is characterized by complement deposition in the absence of immunoglobulin deposition.
Subscribers log in hereLiterature review current through: Jul 2017. | This topic last updated: Dec 09, 2016.References
- Sethi S, Fervenza FC, Zhang Y, et al. Proliferative glomerulonephritis secondary to dysfunction of the alternative pathway of complement. Clin J Am Soc Nephrol 2011; 6:1009.
- Sethi S, Fervenza FC. Membranoproliferative glomerulonephritis: pathogenetic heterogeneity and proposal for a new classification. Semin Nephrol 2011; 31:341.
- Glassock RJ, Bargman JM, Palmer BF, et al. Nephrology Quiz and Questionnaire: 2009. Clin J Am Soc Nephrol 2010; 5:1141.
- Boseman P, Lewin M, Dillon J, Sethi S. Marfan syndrome, MPGN, and bacterial endocarditis. Am J Kidney Dis 2008; 51:697.
- Hulton SA, Risdon RA, Dillon MJ. Mesangiocapillary glomerulonephritis associated with meningococcal meningitis, C3 nephritic factor and persistently low complement C3 and C5. Pediatr Nephrol 1992; 6:239.
- Yamabe H, Johnson RJ, Gretch DR, et al. Hepatitis C virus infection and membranoproliferative glomerulonephritis in Japan. J Am Soc Nephrol 1995; 6:220.
- Yamabe H, Johnson RJ, Gretch DR, et al. Membranoproliferative glomerulonephritis associated with hepatitis C virus infection responsive to interferon-alpha. Am J Kidney Dis 1995; 25:67.
- Alpers CE, Smith KD. Cryoglobulinemia and renal disease. Curr Opin Nephrol Hypertens 2008; 17:243.
- Vella J, Carmody M, Campbell E, et al. Glomerulonephritis after ventriculo-atrial shunt. QJM 1995; 88:911.
- Adam FU, Torun D, Bolat F, et al. Acute renal failure due to mesangial proliferative glomerulonephritis in a pregnant woman with primary Sjögren's syndrome. Clin Rheumatol 2006; 25:75.
- Sethi S, Zand L, Leung N, et al. Membranoproliferative glomerulonephritis secondary to monoclonal gammopathy. Clin J Am Soc Nephrol 2010; 5:770.
- Weening JJ, D'Agati VD, Schwartz MM, et al. The classification of glomerulonephritis in systemic lupus erythematosus revisited. Kidney Int 2004; 65:521.
- Zand L, Fervenza FC, Nasr SH, Sethi S. Membranoproliferative glomerulonephritis associated with autoimmune diseases. J Nephrol 2014; 27:165.
- Fervenza FC, Sethi S, Glassock RJ. Idiopathic membranoproliferative glomerulonephritis: does it exist? Nephrol Dial Transplant 2012; 27:4288.
- Rincón B, Bernis C, Garcia A, Traver JA. Mesangiocapillary glomerulonephritis associated with hydatid disease. Nephrol Dial Transplant 1993; 8:783.
- Goules A, Masouridi S, Tzioufas AG, et al. Clinically significant and biopsy-documented renal involvement in primary Sjögren syndrome. Medicine (Baltimore) 2000; 79:241.
- Denton MD, Singh AK. Recurrent and de novo glomerulonephritis in the renal allograft. Semin Nephrol 2000; 20:164.
- Floege J. Recurrent glomerulonephritis following renal transplantation: an update. Nephrol Dial Transplant 2003; 18:1260.
- Kotanko P, Pusey CD, Levy JB. Recurrent glomerulonephritis following renal transplantation. Transplantation 1997; 63:1045.
- Mathew TH. Recurrence of disease following renal transplantation. Am J Kidney Dis 1988; 12:85.
- Cameron JS. Glomerulonephritis in renal transplants. Transplantation 1982; 34:237.
- Curtis JJ, Wyatt RJ, Bhathena D, et al. Renal transplantation for patients with type I and type II membranoproliferative glomerulonephritis: serial complement and nephritic factor measurements and the problem of recurrence of disease. Am J Med 1979; 66:216.
- Glicklich D, Matas AJ, Sablay LB, et al. Recurrent membranoproliferative glomerulonephritis type 1 in successive renal transplants. Am J Nephrol 1987; 7:143.
- Choy BY, Chan TM, Lai KN. Recurrent glomerulonephritis after kidney transplantation. Am J Transplant 2006; 6:2535.
- Andresdottir MB, Assmann KJ, Hoitsma AJ, et al. Recurrence of type I membranoproliferative glomerulonephritis after renal transplantation: analysis of the incidence, risk factors, and impact on graft survival. Transplantation 1997; 63:1628.
- Lorenz EC, Sethi S, Leung N, et al. Recurrent membranoproliferative glomerulonephritis after kidney transplantation. Kidney Int 2010; 77:721.
- Green H, Rahamimov R, Rozen-Zvi B, et al. Recurrent membranoproliferative glomerulonephritis type I after kidney transplantation: a 17-year single-center experience. Transplantation 2015; 99:1172.
- Habib R, Antignac C, Hinglais N, et al. Glomerular lesions in the transplanted kidney in children. Am J Kidney Dis 1987; 10:198.
- Cheigh JS, Mouradian J, Susin M, et al. Kidney transplant nephrotic syndrome: relationship between allograft histopathology and natural course. Kidney Int 1980; 18:358.
- Andresdottir MB, Assmann KJ, Koene RA, Wetzels JF. Immunohistological and ultrastructural differences between recurrent type I membranoproliferative glomerulonephritis and chronic transplant glomerulopathy. Am J Kidney Dis 1998; 32:582.
- McLean RH, Geiger H, Burke B, et al. Recurrence of membranoproliferative glomerulonephritis following kidney transplantation. Serum complement component studies. Am J Med 1976; 60:60.
- Lien YH, Scott K. Long-term cyclophosphamide treatment for recurrent type I membranoproliferative glomerulonephritis after transplantation. Am J Kidney Dis 2000; 35:539.
- Muczynski KA. Plasmapheresis maintained renal function in an allograft with recurrent membranoproliferative glomerulonephritis type I. Am J Nephrol 1995; 15:446.
- Briganti EM, Russ GR, McNeil JJ, et al. Risk of renal allograft loss from recurrent glomerulonephritis. N Engl J Med 2002; 347:103.
- Roth D, Cirocco R, Zucker K, et al. De novo membranoproliferative glomerulonephritis in hepatitis C virus-infected renal allograft recipients. Transplantation 1995; 59:1676.