Abstract
BackgroundMembranoproliferative glomerulonephritis (MPGN) is an uncommon glomerular disorder that may lead to end stage renal disease (ESRD). With new understanding of the disease pathogenesis, the classical classification as MPGN types I, II, III has changed. Data on post-transplant MPGN, in particular with the newly refined classification, is limited. We present our center’s experience of MPGN after kidney transplantation using the new classification.MethodsThis is a retrospective study of 34 patients with ESRD due to MPGN who received 40 kidney transplants between 1994 and 2014. We reviewed the available biopsies’ data using the new classification. We assessed post transplantation recurrence rate, risk factors of recurrence, the response to therapy and allografts’ survival.ResultsMedian time of follow up was 5.3 years (range 0.5–14 years). Using the new classification, we found that pre-transplant MPGN disease was due to immune complex-mediated glomerulonephritis (ICGN) in 89 % of cases and complement-mediated glomerulonephritis (CGN) in 11 %. Recurrence was detected in 18 transplants (45 %). Living related allografts (P = 0.045), preemptive transplantations (P = 0.018), low complement level (P = 0.006), and the presence of monoclonal gammopathy (P = 0.010) were associated with higher recurrence rate in ICGN cases. Half of the patients with recurrence lost their allografts. The use of ACEi/ARB was associated with a trend toward less allograft loss.ConclusionsMPGN recurs at a high rate after kidney transplantation. The risk of MPGN recurrence increases with preemptive transplantation, living related donation, low complement level, and the presence of monoclonal gammopathy. Recurrence of MPGN leads to allograft failure in half of the cases.
Highlights
Membranoproliferative glomerulonephritis (MPGN) is an uncommon glomerular disorder that may lead to end stage renal disease (ESRD)
All cases were biopsy confirmed MPGN; 65 % were diagnosed as MPGN type I, 9 % were MPGN type II, 21 % were MPGN type III, and 5 % had features of both MPGN type II and III
2) Monoclonal gammopathy: To assess the frequency and association of plasma cell dyscrasias and MPGN recurrence, we identified a total of 19 patients who had serum or urine protein electrophoresis checked at some point before or after kidney transplantation
Summary
Membranoproliferative glomerulonephritis (MPGN) is an uncommon glomerular disorder that may lead to end stage renal disease (ESRD). With new understanding of the disease pathogenesis, the classical classification as MPGN types I, II, III has changed. We present our center’s experience of MPGN after kidney transplantation using the new classification. Membranoproliferative glomerulonephritis (MPGN) is an uncommon glomerular injury pattern characterized by mesangial hypercellularity, endocapillary proliferation, and capillary-wall remodeling. MPGN type III is characterized by subepithelial and subendothelial deposits [5]. Certain systemic diseases such as chronic hepatitis C, autoimmune diseases, and plasma cell dyscrasias, have been associated with MPGN and in these cases it is called secondary MPGN and by histomorphology may present as MPGN types I or III [6]
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