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When the Donor Surprises You: A Case Report.

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|December 20, 2021
PubMed
Summary

Kidney transplants from donors with unknown membranous nephropathy (MN) can be successful. Donor-derived MN was diagnosed in two recipients, but both maintained good kidney function without significant proteinuria.

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Area of Science:

  • Nephrology
  • Transplantation immunology
  • Pathology

Background:

  • Membranous nephropathy (MN) is a leading cause of nephrotic syndrome in adults.
  • The potential for donor-derived MN in kidney transplantation is a recognized but rare complication.
  • Understanding the behavior of donor-derived MN is crucial for recipient management.

Observation:

  • Two kidney transplant recipients received grafts from a donor with no known kidney disease.
  • Histopathological analysis revealed features consistent with donor membranous glomerulopathy in both recipients.
  • Immunofluorescence and immunohistochemistry confirmed IgG4-related donor MN, despite negative anti-PLA2R antibodies.

Findings:

  • The first recipient showed persistent stage 1 MN on biopsy but remained without proteinuria.
  • The second recipient had stage 1 MN on early biopsy, which resolved by the second year.
  • Both recipients maintained stable graft function throughout the follow-up period.

Implications:

  • This case series suggests that donor-derived MN may not always lead to graft dysfunction or significant proteinuria.
  • It highlights the importance of careful histopathological evaluation in kidney transplant recipients with unexplained renal dysfunction.
  • Further research is needed to elucidate the long-term outcomes and management strategies for donor-derived MN.