De novo membranous nephropathy associated with donor‐specific alloantibody

Abstract

Recent evidence suggests that alloantibody may play an aetiological role in the pathogenesis of membranous glomerulopathy in native kidneys. There is an increased awareness of the significance of alloantibody on renal transplant outcome, particularly with the development of more sensitive assays. We describe a kidney transplant patient who developed de novo membranous glomerulopathy (DNMG) with heavy proteinuria in the context of a donor-specific alloantibody (DSA) directed against HLA DQ7. Proteinuria resolved and kidney function stabilized following treatment with mycophenolate mofetil and an angiotensin receptor blocker. The titre of the DSA fell in parallel with resolution of the proteinuria. This is the first reported case of DNMG after kidney transplantation clearly associated with a DSA. We hypothesize that de novo membranous glomerulopathy may be an atypical manifestation of acute antibody-mediated damage. Cases of DNMG should be screened for alloantibody and the presence of alloantibody may influence the choice of therapy.

Post-Transplant Membranous Nephropathy Associated with Chronic Active Antibody-Mediated Rejection and Hepatitis C Infection after Deceased Donor Renal Transplantation

“…Honda et al reported that patients with de novo MN revealed a significantly higher frequency of histological findings associated with AMR compared to control subjects with no de novo MN (4). El Kossi et al reported a possible etiological role for DSA in the pathogenesis of de novo MN (9). Unfortunately, we could not obtain donor HLA information because the kidney was transplanted in Peru eight years previously.…”

Membranous Nephropathy: A Journey From Bench to Bedside

“…De novo development of MN after kidney transplantation in patients who did not have MN as a cause of ESRD occurs occasionally and may be associated with evidence of antibody-mediated rejection and circulating donor-specific antibodies 80–82 . Whereas IgG4 is usually the dominant or co-dominant IgG subclass deposited in recurrent MN, the IgG1 subclass predominates in de novo MN 83 .…”

Membranous nephropathy in children: clinical presentation and therapeutic approach

“…De novo MN, which is the most common de novo glomerulopathy in renal allografts, affects 2–9% of renal allografts [52]. De novo MN typically occurs 24–36 months posttransplant and recurrent MN after 10–24 months [53]. The exact pathogenesis of de novo MN is not clear.…”