The prevalence, impact and main clinicopathological aspects of recurrent and de novo
glomerulonephritis are reviewed, with the use of unpublished data of the authors. The prevalence in
Hungarian recipients was investigated in 697 biopsies obtained for cause and analyzed by light
microscopy and an expanded panel of immunofluorescence. Electron microscopy was performed if
there were symptoms of glomerular disease or the histological alterations or immunfluorescent findings
indicated. Glomerular disease was recorded in 199 biopsies (28.5%): chronic rejection-induced
transplant glomerulopathy in 155 biopsies (22.2%), post-transplantation glomerulonephritis (recurrent,
de novo or undetermined) in 39 (5.5%) biopsies, and systemic disease affecting the glomeruli in 8
biopsies (1.1%). Membranous nephropathy (17), IgA nephritis (9), focal-segmental glomerulosclerosis
(8), mesangial proliferative glomerulonephritis, (3) IgM nephropathy (1) and type I
membranoproliferative glomerulonephritis (1) were identified. Transplant glomerulopathy frequently
coincided with membranous nephropathy. Unusual combinations of histological patterns and/or
immunofluorescent findings were occasionally observed, such as mesangial proliferation with
mesangial and peripheral immune deposits, or epimembranous and mesangial deposits, or mesangial
proliferation and subperimesangial deposits of solely IgM. Post-transplantation GN, more frequent in
males, unfavorably influenced graft survival. Our results and the literature data indicate that posttransplantation
glomerulonephritis relatively rarely involves the white race. Male gender, non-white
ethnicity, younger age and biopsy-proven glomerulonephritis in the native kidney are predictors of posttransplantation
glomerulonephritis. Post-transplantation glomerulonephritis contributes significantly to
late allograft loss; through elevated serum creatinine levels and proteinuria, it precipitates the
cardiovascular mortality and morbidity of the recipient. Limited evidence is available on the
management of post-transplantation glomerulonephritis.
Keywords: De novo Glomerulonephritis, Epidemiology, Kidney Transplant, Recurrent Glomerulonephritis,
Plasmapheresis, Rituximab, Steroids, Immunosuppression, Kidney Biopsy, Membranous Nephropathy.
