Membranoproliferative glomerulonephritis recurrence after kidney transplantation: using the new classification

Alasfar, Sami; Carter‐Monroe, Naima; Rosenberg, Avi Z.; Montgomery, Robert A.; Alachkar, Nada

doi:10.1186/s12882-015-0219-x

Cited by 35 publications

(44 citation statements)

References 13 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…In a recent study, after the exclusion of patients with DDD, a recurrence rate of 41% has been reported [34] . Such a high recurrence rate has been confirmed by a study published in 2016, which evaluated the recurrence rate using the new classification [35] . In another study the recurrence of Ig mediated MPGN was lower (23.5%) and after a follow up of 15 years, the graft survival rate of MPGN patients was similar to those of controls affected by different diseases [36] .…”

Section: Clinical Featuresmentioning

confidence: 75%

Reclassification of membranoproliferative glomerulonephritis: Identification of a new GN: C3GN

Salvadori¹,

Rosso²

2016

WJN

View full text Add to dashboard Cite

This review revises the reclassification of the membranoproliferative glomerulonephritis (MPGN) after the consensus conference that by 2015 reclassified all the glomerulonephritis basing on etiology and pathogenesis, instead of the histomorphological aspects. After reclassification, two types of MPGN are to date recognized: The immunocomplexes mediated MPGN and the complement mediated MPGN. The latter type is more extensively described in the review either because several of these entities are completely new or because the improved knowledge of the complement cascade allowed for new diagnostic and therapeutic approaches. Overall the complement mediated MPGN are related to acquired or genetic cause. The presence of circulating auto antibodies is the principal acquired cause. Genetic wide association studies and family studies allowed to recognize genetic mutations of different types as causes of the complement dysregulation. The complement cascade is a complex phenomenon and activating factors and regulating factors should be distinguished. Genetic mutations causing abnormalities either in activating or in regulating factors have been described. The diagnosis of the complement mediated MPGN requires a complete study of all these different complement factors. As a consequence, new therapeutic approaches are becoming available. Indeed, in addition to a nonspecific treatment and to the immunosuppression that has the aim to block the auto antibodies production, the specific inhibition of complement activation is relatively new and may act either blocking the C5 convertase or the C3 convertase. The drugs acting on C3 convertase are still in different phases of clinical development and might represent drugs for the future. Overall the authors consider that one of the principal problems in finding new types of drugs are both the rarity of the disease and the consequent poor interest in the marketing and the lack of large international cooperative studies.

show abstract

Section: Clinical Featuresmentioning

confidence: 75%

Reclassification of membranoproliferative glomerulonephritis: Identification of a new GN: C3GN

Salvadori¹,

Rosso²

2016

WJN

View full text Add to dashboard Cite

show abstract

“…Membranoproliferative glomerulonephritis recurs at a high rate after kidney transplantation . Furthermore, the recurrence of MPGN leads to an increased rate of allograft failure .…”

Section: Discussionmentioning

confidence: 99%

A case of recurrent proliferative glomerulonephritis with monoclonal IgG deposits or de novo C3 glomerulonephritis after kidney transplantation

et al. 2018

View full text Add to dashboard Cite

Proliferative glomerulonephritis with monoclonal immunoglobulin (Ig)G deposits (PGNMID) is a rare disease with a treatment that is not well established. Several cases of recurrent PGNMID after kidney transplantation have been documented, but almost all cases reported symptoms such as elevated serum creatinine and/or urinary protein levels; subsequently, episode biopsies were performed and a diagnosis was made. This is the case of a 27-year-old man who underwent living-donor kidney transplantation. The aetiology of renal failure was membranoproliferative glomerulonephritis type III, which had been diagnosed at the age of 9 years. Protocol biopsy performed on postoperative day 62 revealed isolated granular C3 deposits in the glomerular capillaries and mesangium. We reviewed the native kidney biopsy and confirmed IgG3 deposition alone, with strong glomerular staining for lambda light chains and negative staining for kappa light chains. Accordingly, we re-diagnosed the aetiology of his renal failure as PGNMID and suspected recurrent PGNMID in the early stage; therefore, we administered plasma exchange therapy. Thereafter, protocol biopsies were performed twice, which revealed persistent isolated C3 deposition; therefore, we made a diagnosis of recurrent PGNMID or C3 glomerulonephritis. Currently, the patient has normal renal function, with negative urine findings for >1 year. Here, we present the histological findings of consecutive allograft biopsies performed in this patient.

show abstract

“…77,78 In one study, of 29 patients, 12 (41%) developed a recurrence within 1 week to 14 months, of whom 5 (42% of patients with recurrence) lost their allografts. 79 In a longitudinal study of 33 patients with MPGN (all types), 21 (49%) developed electron microscopy-proven recurrence in a mean of 4.7 years, of whom 14 (67%) lost their grafts.…”

Section: Tablementioning

confidence: 99%

Selection of Patients for Initial Clinical Trials of Solid Organ Xenotransplantation

et al. 2017

View full text Add to dashboard Cite

Several groups have reported extended survival of genetically-engineered pig organs in nonhuman primates, varying from almost 10 months for life-supporting kidney grafts and >2 years for nonlife-supporting heart grafts to less than 1 month for life-supporting liver and lung grafts. We have attempted to define groups of patients who may not have an option to wait for an allograft. These include kidney, heart, and lung candidates who are highly-allosensitized. In addition, some kidney candidates (who have previously lost at least 2 allografts from rapid recurrence of native kidney disease) have a high risk of further recurrence and will not be offered a repeat allotransplant. Patients with complex congenital heart disease, who may have undergone previous palliative surgical procedures, may be unsuitable for ventricular assist device implantation. Patients dying of fulminant hepatic failure, for whom no alternative therapy is available, may be candidates for a pig liver, even if only as a bridge until an allograft becomes available. When the results of pig organ xenotransplantation in nonhuman primates suggest a realistic potential for success of a pilot clinical trial, highly-selected patients should be offered participation.

show abstract

Membranoproliferative glomerulonephritis recurrence after kidney transplantation: using the new classification

Cited by 35 publications

References 13 publications

Reclassification of membranoproliferative glomerulonephritis: Identification of a new GN: C3GN

Reclassification of membranoproliferative glomerulonephritis: Identification of a new GN: C3GN

A case of recurrent proliferative glomerulonephritis with monoclonal IgG deposits or de novo C3 glomerulonephritis after kidney transplantation

Selection of Patients for Initial Clinical Trials of Solid Organ Xenotransplantation

Contact Info

Product

Resources

About