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De novo membranous glomerulonephritis in renal allografts in children
C Antignac1, N Hinglais, M C Gubler
1INSERM U. 192, Necker Hospital, Paris, France.
Abstract:
The incidence of de novo membranous glomerulonephritis (MGN) in transplanted kidneys is around 1 to 2%. In our series, of the 310 grafts that were examined by immunofluorescence microscopy (IF), 29 (9.3%) showed subepithelial IgG deposits, a pattern consistent with the diagnosis of MGN. Transplant biopsy had been performed because of the occurrence of proteinuria in 8 patients (pts), for suspected rejection in 16 and systematically in the remaining 9 who had no proteinuria and a normal renal function. In all cases the lesions were identified by IF and were confirmed by electron microscopy (EM) in 14 pts. Granular deposits of IgG were diffuse in 22 cases and segmental in 7. Sequential specimens were available in 17 pts and showed the persistence or the increase of the IgG deposits in all patients but one in whom they had disappeared. Age at transplantation (Tx) ranged from 2 years 3 months to 16 years. Grafts were from cadaveric donors in 27 pts and from living related donors in 2 pts. In none of the recipients was MGN the nephropathy of the native kidneys. With a follow-up of 18 to 74 months, 6 pts never developed a proteinuria. In the remaining 23, proteinuria developed 1 to 70 months after Tx, associated with a nephrotic syndrome (NS) in 6 pts.(ABSTRACT TRUNCATED AT 250 WORDS)
Insights
De novo membranous glomerulonephritis (MGN) was found in 9.3% of kidney transplants, a higher incidence than previously reported. Many cases presented without proteinuria, highlighting the need for careful monitoring post-transplant.
Area of Science:
- Nephrology
- Transplant Immunology
- Pathology
Background:
- De novo membranous glomerulonephritis (MGN) is a rare complication of kidney transplantation, typically occurring in 1-2% of cases.
- Subepithelial IgG deposits are the hallmark of MGN, indicating an immune-mediated glomerular injury.
Purpose of the Study:
- To investigate the incidence and characteristics of de novo membranous glomerulonephritis in kidney transplant recipients.
- To evaluate the diagnostic methods and clinical presentation of MGN in the context of kidney transplantation.
Main Methods:
- Immunofluorescence microscopy (IF) was used to examine 310 kidney grafts for subepithelial IgG deposits.
- Electron microscopy (EM) confirmed the diagnosis in a subset of cases.
- Clinical data, including proteinuria, renal function, and follow-up, were analyzed.
Main Results:
- Of 310 grafts, 29 (9.3%) showed IgG deposits consistent with MGN.
- Biopsies were performed due to proteinuria (8 pts), suspected rejection (16 pts), or systematically (9 pts).
- Proteinuria developed in 23 patients post-transplant, with 6 experiencing nephrotic syndrome.
Conclusions:
- The incidence of de novo MGN in kidney transplants may be higher than previously estimated.
- MGN can present without proteinuria, emphasizing the importance of systematic graft evaluation.
- Persistence or increase of IgG deposits suggests ongoing disease activity.