Recurrent Crescentic Membranous Nephropathy in Two Successive Renal Transplants: Association with Choroidal Effusions and Retinal Detachment

Abstract

We report the case of a 50-year-old man in whom crescentic membranous nephropathy recurred in two succesive renal transplants leading rapidly to renal failure. Deterioration of renal function was associated with choroidal effusions and retinal detachments. Multiple serologic tests were negative. High-dose steroids, cyclophosphamide, cyclosporine, plasmapheresis and OKT3 failed to arrest the deterioration of renal function.

Central Serous Chorioretinopathy After Renal Transplantation

“…We found a total of 51 patients with solid-organ transplant-associated CSC in English literature, of which 42 (82%) were RT recipients. 1,9,[11][12][13][14][15][16][17][18][19] Fawzi et al 9 identified 15 patients with CSC after solid-organ transplantation, and in 13 (87%) of these patients CSC occurred after RT. Overrepresentation of RT recipients in their cohort was not explained by factors related to improved survival, enhanced quality of life, or ability to return for follow-up, and the authors suggested that RT recipients may be predisposed to CSC because of their underlying renal disease, the vascular effects of hemodialysis, or the high prevalence of systemic hypertension in patients with end-stage renal disease.…”

“…10 The pathogenesis of CSC remains poorly understood, and in the setting of systemic disorders requiring corticosteroids for therapy, the situation is even further complicated because development of CSC can be related to the underlying disorder, its treatment, or both. Corticosteroids have been suggested to be a common factor in previous reports 1, [11][12][13][14][15][16][17][18][19] on organ transplant-associated CSC, but Fawzi et al 9 recently reported the development of CSC in an RT recipient while on cyclosporine alone without corticosteroids in their cohort of 15 patients. Combined effects of emotional stress, systemic hypertension, and high doses of corticosteroids have generally been thought to contribute to the development of CSC in solid-organ transplant receipients.…”

Posttransplant Recurrence of Primary Glomerulonephritis

“…In a study with protocol biopsies, 6 of 17 cases of MN were identified; of them 6 (35%) were considered to be recurrent IMN and 11 (65%) de novo MN (108). With these difficulties in mind, the rate of IMN recurrence has been estimated to range between 30% and 44% (96,108).…”

Membranous nephropathy: an update

“…The real incidence of recurrence after kidney transplantation (KT) is difficult to assess but it has been estimated to be around 30-44%. 59,84,85 Many patients are diagnosed incidentally during protocol biopsies while others present progressive proteinuria or even full nephrotic syndrome. 86 Spontaneous remission is uncommon.…”