DE NOVO AND RECURRENT MEMBRANOUS GLOMERULOPATHY FOLLOWING KIDNEY TRANSPLANTATION

Abstract

Membranous glomerulopathy, de novo or recurrent, in the allograft kidney is a recognized, albeit uncommon, clinically entity. The records of 936 renal allograft recipients in a 7 1/2 yr period were examined. De novo membranous glomerulopathy developed in 6 patients. The mean onset of nephrotic-range proteinuria after transplantation was at 18.1 mo. (with a range of from 4-30 mo.). De novo membranous glomerulopathy did not adversely affect graft survival. Patients (25) were transplanted for end-stage renal disease caused by membranous glomerulopathy. The rate of recurrence of membranous glomerulopathy in patients who did not lose their allograft to rejection in the immediate postransplant period was 7%. Additional prednisone therapy to the standard immunosuppressive protocol did not appear to be beneficial. One patient, who developed a recurrence of the original lesion, received an HLA-identical kidney. Onset of nephrotic-range proteinuria occurred 4 wk posttransplant. Recurrent membranous glomerulopathy has been reported in 5 other patients. In the 2 recipients of living related allografts nephrotic-range proteinuria developed within 2 wk of the transplant. Patients with end-stage renal disease caused by membranous glomerulopathy who receive a living related allograft, especially one that is HLA-identical, may be at a higher risk for morbidity and for early recurrence. Caution was recommended in the use of a living related transplant for patients with end-stage renal disease caused by membranous glomerulopathy.