Recurrent and de novo glomerulonephritis in the renal allograft

Glomerulonephritis is a major cause of end-stage renal disease (ESRD) and is the primary disease in over a third of patients undergoing renal transplantation. An understanding of the incidence and clinical significance of recurrent glomerulonephritis posttransplantation is therefore essential. Indeed, all forms of glomerulonephritis have been reported to recur histologically after renal transplantation, but the incidence and severity of clinical recurrence varies greatly according to the type of glomerular disease. Large registries report that between 5% to 10% of allografts fail secondary to recurrence of primary disease. This review attempts to clarify some of the salient clinical features of recurrent glomerulonephritis from a body of literature full of anecdotal reports and retrospective studies. There are several excellent reviews on recurrent glomerulonephritis; this review aims to complement these by focusing on more recent developments in the field. Development of de novo glomerulonephritis in the transplant will also be discussed. The recurrence of metabolic diseases such as diabetes mellitus, cystinosis, Fabry's disease, and primary hyperoxaluria will not be discussed.