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Membranous nephropathy: recurrence after kidney transplantation
R Marcen1, F Mampaso, J L Teruel
1Department of Nephrology, Hospital Ramón y Cajal, Madrid, Spain.
Background:
It is supposed that about 5% of dialysis patients had membranous nephropathy as a cause for their renal failure. Despite of this prevalence, only 33 cases of recurrent membranous nephropathy after kidney transplantation have been reported in the English literature.
Methods:
Among 509 recipients of renal allografts, membranous glomerulonephritis was the cause of renal failure in five patients, who received six transplants.
Results:
Recurrence of the disease was observed in three allografts (50%) in three patients, all of them were on treatment with cyclosporin and low-dose prednisone. Proteinuria appeared at 2, 5 and 19 months after grafting. One patient experienced a spontaneous remission after 12 months and he is free from proteinuria and with good renal function after 5 years. The remaining two patients presented progressive renal function deterioration and returned to haemodialysis 24 and 17 months after th appearance of proteinuria. In these patients increasing the immunosuppression did not produce any beneficial effect. One of those patients underwent a second transplant; recurrence of the membranous nephropathy has not been observed after 3 years of follow-up.
Conclusions:
In this study three new cases of recurrence of membranous nephropathy are reported. One patient experienced a spontaneous remission of proteinuria. Recurrence of membranous nephropathy in renal allograft was very high in our series. Its appearance was associated with poor prognosis of the graft in most patients, although spontaneous remission of proteinuria is possible.
Insights
Membranous nephropathy recurrence after kidney transplant is high, with a 50% rate in this study. While often leading to graft failure, spontaneous remission of proteinuria is possible in some kidney transplant recipients.
Area of Science:
- Nephrology
- Transplantation immunology
- Glomerular diseases
Background:
- Membranous nephropathy (MN) is a leading cause of renal failure in 5% of dialysis patients.
- Recurrent MN post-kidney transplant is rare, with only 33 reported cases.
- This study investigates MN recurrence in a cohort of renal allograft recipients.
Observation:
- Five patients with MN as the cause of renal failure received six renal allografts.
- Recurrence of MN was observed in 50% of the allografts (3 out of 6).
- Proteinuria manifested between 2 and 19 months post-transplant.
Findings:
- Three patients experienced recurrent membranous nephropathy, all on cyclosporine and prednisone.
- One patient achieved spontaneous remission of proteinuria and maintained good renal function for 5 years.
- Two patients showed progressive renal deterioration, requiring a return to hemodialysis despite increased immunosuppression.
Implications:
- Recurrence of MN in renal allografts has a high incidence in this series.
- MN recurrence is associated with a poor graft prognosis.
- Spontaneous remission of proteinuria is a possible outcome, offering hope for some patients.