Probability, Predictors, and Prognosis of Posttransplantation Glomerulonephritis

Abstract

Glomerulonephritis (GN) is the leading cause of chronic kidney disease among recipients of renal transplants. Because modern immunosuppressive regimens have reduced the incidence of rejection-related graft loss, the probability and clinical significance of posttransplantation GN (PTGN) requires reevaluation. In this Canadian epidemiologic study, we monitored 2026 sequential renal transplant recipients whose original renal disease resulted from biopsy-proven GN (36%), from presumed GN (7.8%), or from disorders other than GN (56%) for 15 yr without loss to follow-up. Kaplan-Meier estimates of PTGN in the whole population were 5.5% at 5 yr, 10.1% at 10 yr, and 15.7% at 15 yr. PTGN was diagnosed in 24.3% of patients whose original renal disease resulted from biopsy-proven GN, compared with 11.8% of those with presumed GN and 10.5% of those with disorders other than GN. Biopsy-proven GN in the native kidney, male gender, younger age, and nonwhite ethnicity predicted PTGN. Current immunosuppressive regimens did not associate with a reduced frequency of PTGN. Patients who developed PTGN had significantly reduced graft survival (10.2 versus 69.7%; P < 0.0001). In summary, in the Canadian population, PTGN is a common and serious complication that causes accelerated graft failure, despite the use of modern immunosuppressive regimens.

Recurrence of membranoproliferative glomerulonephritis after renal transplantation in Denys–Drash

“…Some reports have suggested that primary EBV or CMV infection (excluded in our case) may trigger the recurrence of MPGN [11,12]. De novo occurrence of post-transplant MPGN type 1 is rare [10].…”

“…Family clustering suggests genetic susceptibility, including complement deficiencies [6][7][8][9]. Recurrence of MPGN after renal transplantation is common in pediatric patients [5,10]. The rate in children has been reported to be 30-77% with graft failure to recurrence in 17-50%.…”

De Novo Glomerular Diseases after Renal Transplantation

“…FSGS was the leading form of de novo glomerular disease in a Canadian review (1). Although recurrent FSGS usually presents early post-transplant as a nephrotic syndrome, de novo FSGS is often detected more than 12 months after transplantation and associated with variable amounts of proteinuria (including nephrotic syndrome), hypertension, and progressive deterioration of renal allograft function.…”

“…Post-transplant GN occurred in 24.3% of allografted patients whose original renal disease resulted from biopsy-proven GN compared with 10.5% of those patients with other types of renal or systemic diseases. Patients who developed glomerular diseases had significantly reduced graft survival (1). Post-transplant glomerular disease is generally divided into recurrences of the same original disease that affected the native kidney of the recipient and de novo disease, in which the post-transplant disease is unrelated to the original disease.…”

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

“…Post-transplant glomerular diseases influence graft function and impair the long-term graft survival (1). This disease is generally divided into two types, recurrent and de novo.…”