Glomerulonephritis after kidney transplantation

Bela Ivanyi, Dejan Dobi, Eva Kemeny, Edit Szederkenyi

Research output: Chapter in Book/Report/Conference proceedingChapter

Abstract

The prevalence, impact and main clinicopathological aspects of recurrent and de novo glomerulonephritis are reviewed, with the use of unpublished data of the authors. The prevalence in Hungarian recipients was investigated in 697 biopsies obtained for cause and analyzed by light microscopy and an expanded panel of immunofluorescence. Electron microscopy was performed if there were symptoms of glomerular disease or the histological alterations or immunfluorescent findings indicated. Glomerular disease was recorded in 199 biopsies (28.5%): chronic rejection-induced transplant glomerulopathy in 155 biopsies (22.2%), post-transplantation glomerulonephritis (recurrent, de novo or undetermined) in 39 (5.5%) biopsies, and systemic disease affecting the glomeruli in 8 biopsies (1.1%).Membranous nephropathy (17), IgA nephritis (9), focal-segmental glomerulosclerosis (8), mesangial proliferative glomerulonephritis, (3) IgM nephropathy (1) and type I membranoproliferative glomerulonephritis (1) were identified. Transplant glomerulopathy frequently coincided with membranous nephropathy. Unusual combinations of histological patterns and/or immunofluorescent findings were occasionally observed, such as mesangial proliferation with mesangial and peripheral immune deposits, or epimembranous and mesangial deposits, or mesangial proliferation and subperimesangial deposits of solely IgM. Post-transplantation GN, more frequent in males, unfavorably influenced graft survival. Our results and the literature data indicate that posttransplantation glomerulonephritis relatively rarely involves the white race. Male gender, non-white ethnicity, younger age and biopsy-proven glomerulonephritis in the native kidney are predictors of posttransplantation glomerulonephritis. Post-transplantation glomerulonephritis contributes significantly to late allograft loss; through elevated serum creatinine levels and proteinuria, it precipitates the cardiovascular mortality and morbidity of the recipient. Limited evidence is available on the management of post-transplantation glomerulonephritis.

Original languageEnglish
Title of host publicationKidney Transplantation
Subtitle of host publicationChallenging the Future
PublisherBentham Science Publishers Ltd.
Pages324-339
Number of pages16
ISBN (Print)9781608054244
DOIs
Publication statusPublished - Dec 1 2012

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Keywords

  • De novo glomerulonephritis
  • Epidemiology
  • Immunosuppression
  • Kidney biopsy
  • Kidney transplant
  • Membranous nephropathy.
  • Plasmapheresis
  • Recurrent glomerulonephritis
  • Rituximab
  • Steroids

ASJC Scopus subject areas

  • Medicine(all)

Cite this

Ivanyi, B., Dobi, D., Kemeny, E., & Szederkenyi, E. (2012). Glomerulonephritis after kidney transplantation. In Kidney Transplantation: Challenging the Future (pp. 324-339). Bentham Science Publishers Ltd.. https://doi.org/10.2174/978160805144111201010324