Allograft Failure in Kidney Transplant Recipients With Membranoproliferative Glomerulonephritis

Angelo, Joseph; Bell, Cynthia; Braun, Michael C.

doi:10.1053/j.ajkd.2010.09.021

Cited by 46 publications

(45 citation statements)

References 22 publications

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“…Cause of death information was not available in the UNOS data set. These mortality rates are lower than previously reported in the UNOS database and likely reflect a younger study population that lacks many of the co-morbidities that contribute to increased mortality in the older general transplant population (35).…”

Section: Discussioncontrasting

confidence: 65%

Long-term Outcome of Renal Transplantation Patients with Henoch-Schönlein Purpura

Samuel¹,

Bell²,

Molony³

et al. 2011

Clinical Journal of the American Society of Nephrology

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SummaryBackground and objectives Although Henoch-Schö nlein purpura (HSP) is the most common form of renal vasculitis in childhood, progression to ESRD is rare, and there are few data on outcomes of renal transplantation in patients with HSP.Design, setting, participants, & measurements This is a matched retrospective cohort study of renal allografts using the United Network of Organ Sharing database (1987 to 2005). Of the 189,211 primary renal allografts, there were 339 with a diagnosis of HSP. The primary end point was allograft survival. ResultsCompared with the remainder of the database, the HSP population was younger (25 years versus 46 years), and had a higher proportion of women (47% versus 40%), live donors (50% versus 35%), and Caucasians (77% versus 60%). Controlling for age, gender, donor source, ethnicity, and year of transplantation, death-censored graft survival for patients with HSP was 80.0% at 5 years and 58.8% at 10 years compared with 79.0% at 5 years and 55.4% at 10 years in the non-HSP population. Among patients with reported causes of graft loss, failure from recurrent disease occurred in 13.6% of patients with HSP, compared with 6.6% in the non-HSP population. When analyzing allograft survival in recipients with HSP compared with those with IgA nephropathy, there was no difference in 10-year allograft survival (58.4% and 59.3%, respectively). ConclusionsThese data indicate that although there is an increased risk of graft failure attributable to recurrent disease in patients with HSP, a diagnosis of HSP has little effect on overall renal allograft survival.

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Section: Discussioncontrasting

confidence: 65%

Long-term Outcome of Renal Transplantation Patients with Henoch-Schönlein Purpura

Samuel¹,

Bell²,

Molony³

et al. 2011

Clinical Journal of the American Society of Nephrology

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“…The incidence of allograft loss at 10 years because of recurrent MPGN I was 14.4% (95% confidence interval, 7.6% to 26.4%), which was similar to the incidence of recurrent FSGS. In an analysis of nearly 190,000 renal transplant patients in the United Network for Organ Sharing database, the incidence of allograft loss at 10 years because of recurrent MPGN I was similarly 14.5%, which was higher than other glomerulonephritides combined (36). We must keep in mind that the histologic changes seen on transplant glomerulopathy have the MPGN pattern of injury, and many of the recurrence rates might be overestimated.…”

Section: Recurrence Post-transplantationmentioning

confidence: 99%

Update on Membranoproliferative GN

Masani

Jhaveri²,

Fishbane³

2014

Clinical Journal of the American Society of Nephrology

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Membranoproliferative GN represents a pattern of injury seen on light microscopy. Historically, findings on electron microscopy have been used to further subclassify this pathologic entity. Recent advances in understanding of the underlying pathobiology have led to a proposed classification scheme based on immunofluorescence findings. Dysregulation of the complement system has been shown to be a major risk factor for the development of a membranoproliferative GN pattern of injury on kidney biopsy. Evaluation and treatment of this complex disorder rest on defining the underlying mechanisms.

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“…Progression toward ESRD occurs in .50% of patients within 10 years of diagnosis, with younger patients more prone to development of ESRD than older patients (4). Finally, recurrence of DDD after kidney transplantation is common (5,6).…”

Section: Introductionmentioning

confidence: 99%

Eculizumab in Pediatric Dense Deposit Disease

Oosterveld¹,

Garrelfs²,

Höppe

et al. 2015

Clinical Journal of the American Society of Nephrology

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Background and objectives Dense deposit disease (DDD), a subtype of C3 glomerulopathy, is a rare disease affecting mostly children. Treatment options are limited. Debate exists whether eculizumab, a monoclonal antibody against complement factor C5, is effective in DDD. Reported data are scarce, especially in children.Design, setting, participants, & measurements The authors analyzed clinical and histologic data of five pediatric patients with a native kidney biopsy diagnosis of DDD. Patients received eculizumab as therapy of last resort for severe nephritic or nephrotic syndrome with alternative pathway complement activation; this therapy was given only when the patients had not or only marginally responded to immunosuppressive therapy. Outcome measures were kidney function, proteinuria, and urine analysis.Results In all, seven disease episodes were treated with eculizumab (six episodes of severe nephritic syndrome [two of which required dialysis] and one nephrotic syndrome episode). Median age at treatment start was 8.4 (range, 5.9-13) years. For three treatment episodes, eculizumab was the sole immunosuppressive treatment. In all patients, both proteinuria and renal function improved significantly within 12 weeks of treatment (median urinary protein-to-creatinine ratio of 8.5 [range, 2.2-17] versus 1.1 [range, 0.2-2.0] g/g, P,0.005, and eGFR of 58 [range, 17-114] versus 77 [range, 50-129] ml/min per 1.73 m 2 , P,0.01). A striking finding was the disappearance of leukocyturia within 1 week after the first eculizumab dose in all five episodes with leukocyturia at treatment initiation.Conclusions In this case series of pediatric patients with DDD, eculizumab treatment was associated with reduction in proteinuria and increase in eGFR. Leukocyturia resolved within 1 week of initiation of eculizumab treatment. These results underscore the need for a randomized trial of eculizumab in DDD.

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Allograft Failure in Kidney Transplant Recipients With Membranoproliferative Glomerulonephritis

Cited by 46 publications

References 22 publications

Long-term Outcome of Renal Transplantation Patients with Henoch-Schönlein Purpura

Long-term Outcome of Renal Transplantation Patients with Henoch-Schönlein Purpura

Update on Membranoproliferative GN

Eculizumab in Pediatric Dense Deposit Disease

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