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De Novo Membranous Nephropathy Associated With Antibody-Mediated Rejection in Kidney Transplant Recipients

Marcos Vinicius de Sousa1, Luis Gustavo Romani Fernandes1, Leandro Luiz Lopes de Freitas2

  • 1Renal Transplant Research Laboratory, Renal Transplant Unit, Division of Nephrology, Department of Internal Medicine, School of Medical Sciences, University of Campinas (UNICAMP), Campinas, São Paulo, Brazil; Laboratory of Translational Immunology, Department of Internal Medicine, School of Medical Sciences, University of Campinas, (UNICAMP), Campinas, São Paulo, Brazil.

Transplantation Proceedings
|March 15, 2022
PubMed
Abstract

Insights

Membranous nephropathy (MN) is a rare complication after kidney transplant, often linked to antibody-mediated rejection (AMR). Early detection and treatment are crucial for graft survival in these complex cases.

Area of Science:

  • Nephrology
  • Transplant Immunology
  • Autoimmune Diseases

Background:

  • Membranous nephropathy (MN) is a rare autoimmune kidney disease.
  • It can lead to nephrotic syndrome and end-stage kidney disease.
  • MN recurrence post-kidney transplant affects 30-40% of recipients.

Observation:

  • This study examined four kidney transplant recipients with membranous nephropathy and antibody-mediated rejection (AMR).
  • MN developed 10-92 months post-transplant, associated with de novo donor-specific antibodies (anti-HLA).
  • All cases showed typical MN morphology, with subepithelial deposits and spikes; IgG4 was negative, but M-type phospholipase A2 receptor was detected in three.

Findings:

  • De novo MN is a rare manifestation of AMR in kidney transplant recipients.
  • Despite treatment with IVIg and plasmapheresis, donor-specific antibodies persisted.
  • Two grafts were lost due to chronic failure or infection; two remain functioning with antiproteinuric therapy.

Implications:

  • De novo MN in kidney transplant recipients signifies antibody-mediated activation, even with immunosuppression.
  • The presence of M-type phospholipase A2 receptor antibodies suggests a specific pathogenic pathway.
  • Understanding this association is vital for managing kidney transplant outcomes and preventing graft loss.

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