Drusen Formation in Type II Membranoproliferative Glomerulonephritis after Renal Transplantation

Abstract

Abstract Type II membranoproliferative glomerulonephritis (MPGN) is a systemic disease that almost invariably recurs in renal allografts. This is a case of a 45-year-old woman with biopsy proven type II MPGN that led to renal failure 10 years after diagnosis. During the fifth month after cadaveric transplantation she was treated with pulse doses of methylprednisolone owing to acute T-cell mediated rejection without pathohistological signs of type II MPGN recurrence. One month later the patient was hospitalized due to acute bilateral vision deterioration. Ophthalmoscopy showed bilateral, multifocal drusen, concentrating in the posterior pole, and exudative ablation of the retinal pigment epithelium. Ocular coherence tomography (OCT) revealed focal retinal pigment epithelial elevation and detachments. The patient was treated with methylprednisolone (1 mg/kg) for 3 days. Therapy led to regression of exudation and flattening of the pigment epithelial detachments with discrete subjective visual improvement. Type II MPGN almost invariably recurs and leads to graft failure in 50% of cases. Our patient had evident chronic eye changes due to type II MPGN leaving allograft function intact during the first year of follow-up. Considering these potentially devastating effects of the disease, type II MPGN patients should be observed carefully from both the renal and eye point of view, because the severity of ocular changes, like in our case, is not always in line with allograft function.