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[In Process Citation].
Hans-Peter Marti1, Christina Dörje2, Erik H Strøm3
1Department of Medicine, Haukeland University Hospital and University of Bergen, Bergen, Norwegen.
Therapeutische Umschau. Revue Therapeutique
|February 28, 2015
Summary
Glomerulonephritis recurrence is a major cause of long-term kidney transplant failure, varying by disease type and diagnosis method. New therapies show promise for specific glomerulonephritis cases, improving transplant outcomes.
Area of Science:
- Nephrology
- Transplantation Immunology
- Glomerular Diseases
Background:
- Recurrence of glomerulonephritis post-kidney transplantation is a significant factor in long-term allograft failure.
- The frequency and impact of recurrence depend on diagnostic methods (clinical vs. biopsy) and the primary glomerular disease.
- While overall long-term allograft survival is comparable to other renal diseases, some studies indicate a slightly worse prognosis for glomerulonephritis patients.
Purpose of the Study:
- To review the impact of glomerulonephritis recurrence on kidney transplant outcomes.
- To highlight emerging therapeutic strategies for specific recurrent glomerulonephritides.
- To emphasize that glomerulonephritis is not a contraindication for kidney transplantation.
Main Methods:
- Literature review and analysis of existing studies on glomerulonephritis recurrence after kidney transplantation.
- Examination of diagnostic criteria and their influence on recurrence rates.
- Evaluation of recent therapeutic advancements and their efficacy in smaller patient cohorts.
Main Results:
- Recurrence rates vary significantly, with IgA nephropathy having >50% recurrence but often slow progression, while focal segmental glomerulosclerosis and membranoproliferative glomerulonephritis show rapid progression and poorer prognosis.
- New therapies, including rituximab and eculizumab, show promise for focal segmental glomerulosclerosis, idiopathic membranous nephropathy, membranoproliferative glomerulonephritis type 2, IgA nephropathy, and atypical hemolytic uremic syndrome.
- Recurrence is the third leading cause of kidney transplant failure, after rejection and death with a functioning graft.
Conclusions:
- Glomerulonephritis recurrence is a critical concern in kidney transplantation, with varied outcomes based on the specific disease.
- Advances in understanding pathogenesis have led to targeted therapies offering new hope for managing recurrent glomerulonephritis.
- Kidney transplantation remains a viable option for patients with glomerulonephritis, despite the risk of recurrence.
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