Recurrent Glomerular Disease after Kidney Transplantation: Diagnostic and Management Dilemmas

Audrey Uffing; Frank Hullekes; Leonardo V Riella; Jonathan J Hogan

doi:10.2215/CJN.00280121

Recurrent Glomerular Disease after Kidney Transplantation: Diagnostic and Management Dilemmas

Clin J Am Soc Nephrol. 2021 Nov;16(11):1730-1742. doi: 10.2215/CJN.00280121. Epub 2021 Oct 22.

Authors

Audrey Uffing^{1

2}, Frank Hullekes¹, Leonardo V Riella^{1

3}, Jonathan J Hogan⁴

Affiliations

¹ Renal Division, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts.
² Department of Nephrology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
³ Department of Surgery, Center for Transplantation Sciences, Massachusetts General Hospital, Boston, Massachusetts.
⁴ Division of Renal Electrolyte and Hypertension, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania.

Abstract

Recurrent glomerular disease after kidney transplant remains an important cause of allograft failure. Many of the different entities post-transplant still suffer from incomplete knowledge on pathophysiology, and therefore lack targeted and effective therapies. In this review, we focus on specific clinical dilemmas encountered by physicians in managing recurrent glomerular disease by highlighting new insights into the understanding and treatment of post-transplant focal segmental glomerulosclerosis, membranous nephropathy, atypical hemolytic uremic syndrome, C3 glomerulopathy, amyloid light-chain (AL) amyloidosis, and IgA nephropathy.

Keywords: allograft failure; glomerular disease; glomerulonephritis; kidney transplantation; kidney transplantation series; recurrent glomerular disease.

Publication types

Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't

MeSH terms

Amyloidosis / complications
Antibodies, Monoclonal, Humanized / therapeutic use
Atypical Hemolytic Uremic Syndrome / diagnosis
Atypical Hemolytic Uremic Syndrome / genetics
Atypical Hemolytic Uremic Syndrome / therapy*
Autoantibodies / blood
Complement C3 / metabolism
Complement Inactivating Agents / therapeutic use
Genetic Testing
Glomerulonephritis / diagnosis*
Glomerulonephritis / genetics
Glomerulonephritis / pathology
Glomerulonephritis / therapy*
Humans
Kidney Failure, Chronic / etiology
Kidney Failure, Chronic / surgery
Kidney Transplantation*
Nephrectomy
Plasmapheresis
Predictive Value of Tests
Receptors, Phospholipase A2 / immunology
Recurrence
Risk Factors

Substances

Antibodies, Monoclonal, Humanized
Autoantibodies
C3 protein, human
Complement C3
Complement Inactivating Agents
PLA2R1 protein, human
Receptors, Phospholipase A2
eculizumab