Morphology and Pathogenesis of Glomerulopathy in Cadaver Kidney Allografts Treated with Antilymphocyte Globulin

Transplant Glomerulopathy: Ultrastructural Abnormalities Occur Early in Longitudinal Analysis of Protocol Biopsies

“…Ultrastructural changes were postulated to occur in three stages (4,5,23,24); however, these studies used clinically indicated biopsies with limited sequential ultrastructural data. Our study found that ultrastructural changes were detectable very early (from 1 month) in patients destined for subsequent TXG, long before the classical light microscopy pathology and graft dysfunction was evident.…”

“…The spectrum of abnormalities include duplication of the glomerular capillary basement membrane, mesangial interposition, electron luscent widening of subendothelial space with occasional flocculent densities and/or fibrillary material, mesangial matrix expansion and multi-lamination of the peritubular capillary basement membrane (PTC-BM) (3)(4)(5)(6)(7)(8)(9). Data derived from cross-sectional studies have demonstrated associations with circulating anti-donor HLA antibodies, endothelial C4d deposition in peritubular capillaries and glomerular infiltration of activated T cells (10)(11)(12)(13).…”

Idiopathic and Secondary Mesangiocapillary Glomerulonephritis

“…They are characterized by widening of the lami na rara interna of the capillary basement membrane, endothelial detachment and formation of new subendothelial basement membrane. This process often results in a double outline of the capillary wall [29]. Mesangial changes are less conspicuous and consist of rarefaction followed by sclerosis, but usually little cellular prolifera tion [30].…”

“…It was soon recognized that the double-track appear ance is not limited to the idiopathic MCGN, but also occurs in a variety of diseases affecting glomeruli such as shunt nephritis [6][7][8], nephritis of chronic suppurative infection [9] and of subacute bacterial endocarditis [10], lupus nephritis [I I, 12], cryoglobulinemia [13][14][15], glo merulopathy associated with hepatitis B infection [16], malarial nephropathy [17,18], schistosomal nephropathy [19,20], heroin nephropathy [21,22], sickle cell disease [23][24][25], hemolytic-uremic syndrome [26][27][28], transplant nephropathy [29,30], radiation nephritis [31,32] and nephrotic syndrome associated with tumors, especially leukemias and malignant lymphomas [33,34], Further more, minor degrees of mesangial interposition are found in many chronic, occasionally also in acute glo merular diseases of various origins'.…”

Immunobiology of Chronic Renal Transplant Rejection

“…The glomeruli show a variety of abnormalities, including in creased mesangial matrix deposition with partial or complete collapse of the capillary tuft or focal glomerulosclerosis [8], Hamburg er et al [9] were the first to describe a lesion unique to renal transplants and coined the term rejection glomerulonephritis; this lesion is considered a glomerular manifestation spe cific for chronic rejection and has also been named rejection nephropathy [10], transplant glomerular disease [11,12], rejection trans plant glomerulopathy [13], transplant glomer ulopathy [14], or allograft glomerulopathy [15]. Routine light microscopy shows wide spread reduplication of the glomerular base ment membrane, a moderate increase in mes angial matrix and interposition of matrix and cells, resembling membranoproliferative glo merulonephritis [16].…”