TY - JOUR
T1 - Recurrent and de novo Glomerulonephritis After Kidney Transplantation
AU - Lim, Wai H.
AU - Shingde, Meena
AU - Wong, Germaine
PY - 2019/8/14
Y1 - 2019/8/14
N2 - The prevalence, pathogenesis, predictors, and natural course of patients with recurrent glomerulonephritis (GN) occurring after kidney transplantation remains incompletely understood, including whether there are differences in the outcomes and advances in the treatment options of specific GN subtypes, including those with de novo GN. Consequently, the treatment options and approaches to recurrent disease are largely extrapolated from the general population, with responses to these treatments in those with recurrent or de novo GN post-transplantation poorly described. Given a greater understanding of the pathogenesis of GN and the development of novel treatment options, it is conceivable that these advances will result in an improved structure in the future management of patients with recurrent or de novo GN. This review focuses on the incidence, genetics, characteristics, clinical course, and risk of allograft failure of patients with recurrent or de novo GN after kidney transplantation, ascertaining potential disparities between "high risk" disease subtypes of IgA nephropathy, idiopathic membranous glomerulonephritis, focal segmental glomerulosclerosis, and membranoproliferative glomerulonephritis. We will examine in detail the management of patients with high risk GN, including the pre-transplant assessment, post-transplant monitoring, and the available treatment options for disease recurrence. Given the relative paucity of data of patients with recurrent and de novo GN after kidney transplantation, a global effort in collecting comprehensive in-depth data of patients with recurrent and de novo GN as well as novel trial design to test the efficacy of specific treatment strategy in large scale multicenter randomized controlled trials are essential to address the knowledge deficiency in this disease.
AB - The prevalence, pathogenesis, predictors, and natural course of patients with recurrent glomerulonephritis (GN) occurring after kidney transplantation remains incompletely understood, including whether there are differences in the outcomes and advances in the treatment options of specific GN subtypes, including those with de novo GN. Consequently, the treatment options and approaches to recurrent disease are largely extrapolated from the general population, with responses to these treatments in those with recurrent or de novo GN post-transplantation poorly described. Given a greater understanding of the pathogenesis of GN and the development of novel treatment options, it is conceivable that these advances will result in an improved structure in the future management of patients with recurrent or de novo GN. This review focuses on the incidence, genetics, characteristics, clinical course, and risk of allograft failure of patients with recurrent or de novo GN after kidney transplantation, ascertaining potential disparities between "high risk" disease subtypes of IgA nephropathy, idiopathic membranous glomerulonephritis, focal segmental glomerulosclerosis, and membranoproliferative glomerulonephritis. We will examine in detail the management of patients with high risk GN, including the pre-transplant assessment, post-transplant monitoring, and the available treatment options for disease recurrence. Given the relative paucity of data of patients with recurrent and de novo GN after kidney transplantation, a global effort in collecting comprehensive in-depth data of patients with recurrent and de novo GN as well as novel trial design to test the efficacy of specific treatment strategy in large scale multicenter randomized controlled trials are essential to address the knowledge deficiency in this disease.
KW - recurrent disease
KW - glomerulonephritis
KW - kidney transplantation
KW - recurrent glomerulonephritis
KW - de novo glomerulonephritis
KW - allograft failure
KW - FOCAL SEGMENTAL GLOMERULOSCLEROSIS
KW - IDIOPATHIC MEMBRANOUS NEPHROPATHY
KW - PHOSPHOLIPASE A(2) RECEPTOR
KW - ANCA-ASSOCIATED VASCULITIS
KW - HEMOLYTIC-UREMIC SYNDROME
KW - MONOCLONAL IGG DEPOSITS
KW - I MEMBRANOPROLIFERATIVE GLOMERULONEPHRITIS
KW - POSTTRANSPLANT NEPHROTIC SYNDROME
KW - MINIMAL CHANGE DISEASE
KW - RENAL-TRANSPLANTATION
U2 - 10.3389/fimmu.2019.01944
DO - 10.3389/fimmu.2019.01944
M3 - Review article
C2 - 31475005
SN - 1664-3224
VL - 10
JO - Frontiers in Immunology
JF - Frontiers in Immunology
IS - AUG
M1 - 1944
ER -