SAT-378 De-novo and recurrent glomerulonephritis in renal allograft recipients – a single centre experience

Abstract

Glomerulonephritis (GN) in the renal allograft recipient, especially recurrence of the native kidney disease can affect the long-term graft outcome. Data from our country is scant. When as many as 54.4% have Chronic Kidney Disease stage 5 (CKD 5) as the initial presentation of renal illness, the native kidney disease is frequently unknown. We studied the pattern of GN in the renal allograft recipients from our centre over a six year period. Renal allograft recipients over a six year period (2003 to 2008) were retrospectively evaluated to look for appearance of GN in the follow-up period. There were 548 patients who underwent transplantation during this period, of which, the native kidney disease (NKD) as GN was known in 83 patients (15.2%). The most common NKD was IgA nephropathy (33.7%) followed by focal and segmental glomerulosclerosis (FSGS) in 27.6%. The mean time of onset of renal illness to CKD 5 was 41.8 (± 46.36) months, ranging from one month to 16 years. 36 patients (6.4 %) developed GN, of which eleven had recurrence of GN, eight had de-novo GN while sixteen had a de-novo GN where NKD was unknown. The most common GN were IgA nephropathy (9, 28.1%) and FSGS (9, 28.1%). The most common recurrent GN was IgA nephropathy in five patients (62.5%). The most common de novo GN in those with a known NKD was calcineurin (CNI) induced thrombotic microangiopathy (TMA) in five patients (62.5%) while the most common de novo GN in those with unknown NKD were IgA nephropathy (4, 26.7%) and FSGS (4, 26.7%). Renal allograft biopsy was done mostly for proteinuria (18, 56.3%) followed by deterioration in renal function (9, 28.1%). Biopsy was done 17.5 (±15) months post-transplant with the minimum duration being as low as six days. The mean period of follow up of patients with denovo/recurrent GN (from the time of diagnosis) was 25.8(±22.3) months. In patients with denovo CNI induced TMA, graft function improved after the withdrawal of CNI. Excluding the above subgroup of patients, the rate of decline in GFR in patients with recurrent/denovo GN over the mean follow up period was 0.39ml/min/month. Graft loss was observed in 8 patients with recurrent/denovo GN. Glomerulonephritis (GN) in the renal allograft recipient is not uncommon. Of the 548 patients, 6.4 % developed GN of which the most common was IgA nephropathy. The most common recurrent GN was IgA nephropathy while the most common de novo GN in those with a known NKD was calcineurin induced thrombotic microangiopathy while the most common de novo GN in those with unknown NKD were IgA nephropathy and FSGS.