Abstract
Despite advances in prevention of acute rejection and improved short- and long-term kidney graft survival, RGN remains problematic and poorly characterized. This study analyzed the incidence of various histological types of RGN in our center in the last twenty years. It also sought to identify the potential risk factors for recurrence. We studied 1319 renal transplant patients who had been followed at our center (1992-2012). 451 patients underwent percutaneous needle biopsy of the transplanted kidney. Demographic, clinical and histological features of the RGN were compared with a control group (n. 58 with no GN). Potential risk factors for disease recurrence were analyzed. The histological diagnoses were different: 156/451 (34.58%) chronic allograft nephropathy (CAN), 89/451 (19.73%) GN, 84/451 (18.62%) acute rejections, 78/451 (17.29%) acute tubular necroses, 26/451 (5.76%) normal, 11/451 (2.43%) thrombotic microangiopathy, 7/451 (1.55%) cortical necrosis. For 39/89 (43.82%) patients of the GN group, primary kidney disease was unknown. The histological diagnoses in this group were: 17/39 (43.58%) IgA nephropathy (IgAN), 7/39 (17.94%) FSGS, 5/39 (12.82%) necrotizing extracapillary GN, 6/39 (15.38%) MPGN. 22/89 (24.71%) of patients showed a de novo GN. The histological diagnoses were: 8/22 (36.4%) IgAN, 5/22 (22.7%) FSGS, 2/22 (9.1%) necrotizing extracapillary GN, 3/22 (13.63%) MGN, 1/22 (4.54%) amyloidosis. The remaining 28/89 (31.46%) showed RGN with 22/28 (78.57%) IgAN, 3/28 (10.71%) FSGS, 3/28 (10.71%) MPGN. Interestingly, in our cohort we found a significant correlation of RGN with young age ( 36.6 ± SD in recurrent GN vs. 42.4 ± SD in non recurrent GN (p=0.02)) and the presence of CAN (8/28 in RGN vs. 4/58 in control group (p=0.006)). We did not find significative differences between RGN on control group for age at transplant, sex, living/deceased donors, duration of dialysis, type of dialysis if HD or PD, delayed graft function recovery, type of immunosuppressive therapy, re-transplantation, acute rejection, chronic allograft nephropathy.Post-transplant glomerulonephritis can be de novo or recurrence of the original glomerular disease. In our study, we found IgAN as the most common form of RGN. It is possible that the young age of the transplant patient and the development of a chronic allograft dysfunction during transplantation expose the patient to the development of a RGN.
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