Glomerulonephritis in renal allografts-A clinicopathological study

Glomerulonephritis, recurrence/de novo is a frequent complication of kidney transplantation that may worsen the graft function and impair long-term graft survival. This study aims to analyze the incidence of post-transplant glomerulonephritis at our center, the different morphological patterns, predictors of recurrence, clinical manifestations and outcome.

One hundred thirty-six post-transplant biopsies from January 2015 to December 2023 diagnosed as glomerulonephritis based on light microscopy and immunofluorescence findings with/without electron microscopic study were included.

Most common glomerulopathy seen in the allograft biopsies was IgA nephropathy (61.8%) followed by FSGS (16.9%). Recurrence was significantly higher in younger patients, <40 years. Time of diagnosis varied from 5 th post-transplant day to 18 years. Proteinuria was the most common symptom in these patients. Urine protein creatinine ratio was a strong predictor of graft survival as failure rates were significantly higher in cases with urine PCR >3.

Glomerulonephritis in allograft biopsies can impact patient and graft outcome. Diagnosis requires high index of clinical suspicion, correlation with clinical features and treatment history, knowledge of native kidney disease for categorization into recurrent or de novo disease, assessment of renal function parameters such as urine PCR, serum urea and creatinine, and tissue biopsy for histopathological, immunofluorescence, and electron microscopic examination.