The pathology and clinical features of early recurrent membranous glomerulonephritis.

We assessed the earliest manifestations of recurrent membranous glomerulonephritis (MGN) in renal allografts. Clinical, laboratory and pathologic data were reviewed in 21 patients at the initial biopsy within 4 months post-transplant with evidence of MGN and on follow-up biopsies, compared to a biopsy control group of eight transplants without recurrent MGN. The mean time of first biopsy with pathologic changes was 2.7 months. In each earliest biopsy, immunofluorescence (IF) showed granular glomerular basement membrane (GBM) staining for C4d, IgG, kappa and lambda. IF for C3 was negative or showed trace staining in 16/21. On each MGN biopsy positive by IF, 14/19 showed absence of deposits or rare tiny subepithelial deposits by electron microscopy (EM). At the earliest biopsy, the mean proteinuria was 1.1 g/day; 16 patients had <1 g/day proteinuria. Follow-up was available in all patients (mean 35 months posttransplant). A total of 13 patients developed >1 g/day proteinuria; 12 were treated with: rituximab (n = 8), ACEI and increased prednisone dose (n = 2), ACEI or ARB only (n = 2). All patients showed reduction in proteinuria after treatment. A total of 11/16 patients showed progression of disease by EM on follow-up biopsy. Recognition of early allograft biopsy features aids in diagnosis of recurrent MGN before patients develop significant proteinuria.

Rodriguez EF ，Cosio FG ，Nasr SH ，Sethi S ，Fidler ME ，Stegall MD ，Grande JP ，Fervenza FC ，Cornell LD ... -  《-》

Membranous glomerulonephritis associated with hepatitis C virus infection in renal transplant patients.

Morales JM ，Pascual-Capdevila J ，Campistol JM ，Fernandez-Zatarain G ，Muñoz MA ，Andres A ，Praga M ，Martinez MA ，Usera G ，Fuertes A ，Oppenheimer F ，Artal P ，Darnell A ，Rodicio JL ... -  《TRANSPLANTATION》

[Efficiency of rituximab treatment for recurrence of membranous glomerulopathy after renal transplantation].

Wéclawiak H ，Ribes D ，Modesto A ，Kamar N ，Durand D ，Rostaing L ... -  《-》

Clinicopathological analysis of allogeneic hematopoietic stem cell transplantation-related membranous glomerulonephritis.

Allogeneic hematopoietic stem cell transplantation (HSCT)-related membranous glomerulonephritis (MGN) is poorly understood. A total of 830 patients who underwent HSCT at Toranomon Hospital from 2000 to 2012 were evaluated retrospectively, including 621 patients receiving umbilical cord blood transplantation (UCBT) and 208 patients receiving unrelated bone marrow transplantation. MGN was diagnosed in 5 patients after UCBT (versus none after bone marrow transplantation) and occurred concomitantly with chronic graft-versus-host disease after cessation of immunosuppression. Light microscopy did not show any definite spikes or bubbling of the glomerular basement membrane (GBM) in all 5 patients. In 1 patient (case 5), endocapillary proliferative lesions with fibrin-like deposits were noted in addition to MGN findings. Immunofluorescence demonstrated granular deposits of immunoglobulin G (IgG; IgG1 and IgG4) along the GBM with negativity for C3, C4, and C1q in 4 patients (cases 1-4), whereas case 5 showed positivity for IgG (IgG1, IgG2, IgG3, and IgG4) as well as for C3, C4, and C1q. Electron microscopy revealed electron-dense deposits in the subepithelial space of the GBM in cases 1-4. In case 5, electron-dense deposits were present in the mesangium and the subendothelial space of the GBM, as well as in the subepithelial space. After treatment with immunosuppressants (prednisolone and/or cyclosporin) or angiotensin-converting enzyme inhibitors, complete remission with disappearance of proteinuria was achieved 12.2 months in all 5 patients, but nephrotic-range proteinuria relapsed in 2 patients during follow-up. Serum anti-PLA2R autoantibody was negative in 3 patients. HSCT-related MGN only occurred after UCBT. We believe that there were 2 morphologic patterns: early MGN and membranoproliferative pattern glomerulonephritis.

Hiramatsu R ，Ubara Y ，Sawa N ，Hasegawa E ，Kawada M ，Imafuku A ，Sumida K ，Mise K ，Yamanouchi M ，Ueno T ，Sekine A ，Hayami N ，Suwabe T ，Hoshino J ，Takaichi K ，Ohashi K ，Fujii T ，Wake A ，Taniguchi S ... -  《-》

Beneficial effect of rituximab in the treatment of recurrent idiopathic membranous nephropathy after kidney transplantation.

Sprangers B ，Lefkowitz GI ，Cohen SD ，Stokes MB ，Valeri A ，Appel GB ，Kunis CL ... -  《-》