Evaluation of Recurrent Glomerulonephritis in Kidney Allografts

Abstract

Abstract The clinical records and biopsy and nephrectomy specimens from 320 patients treated at the Duke University Medical Center between 1965 and 1977 were examined to determine the type and incidence of recurrent glomerulonephritis in the allograft. The diagnosis of recurrent disease required that the histopathologic features of the transplanted kidney resemble those of the diseased native kidney by immunofluorescence and light and electron microscopy. Of 204 patients with tissue available for evaluation from both the native and the transplanted kidney, 117 had some form of chronic glomerulonephritis. Of the 117, there were 61 whose disease could be subclassified further. Idiopathic membranous glomerulonephritis was documented in seven patients, IgA nephropathy in five, focal glomerular sclerosis in 20, type 1 membranoproliferative glomerulonephritis in 16, type 2 membranoproliferative glomerulonephritis in two, proliferative glomerulonephritis in five, crescentic proliferative glomerulonephritis in four and anti-glomerular basement membrane disease in two. In this group of 61, there were 19 patients with 21 allografts in which there was evidence of recurrent glomerulonephritis including four each with idiopathic membranous glomerulonephritis and focal glomerular sclerosis, seven with type 1 membranoproliferative glomerulonephritis, two each with type 2 membranoproliferative glomerulonephritis and anti-glomerular basement membrane disease and one each with IgA nephropathy and crescentic proliferative glomerulonephritis. There were 104 living related donor kidneys grafted into patients with chronic glomerulonephritis, and 78 had tissue available for evaluation. In this group, 15 patients had 16 grafts with recurrent glomerulonephritis. There were 55 cadaveric donor kidneys transplanted into patients with chronic glomerulonephritis, and 39 had tissue available for evaluation. In this group, there were five examples of recurrent glomerulonephritis. Thus, recurrent glomerulonephritis can occur in a variety of histologic subtypes, and in this study population, recurrent glomerulonephritis was more common in allografts from living related donors.