Darji, Prakash I, Patel, Himanshu A, Darji, Bhavya P, Sharma, Ajay and Halawa, Ahmed 
ORCID: 0000-0002-7305-446X
(2022)
Is <i>de novo</i> membranous nephropathy suggestive of alloimmunity in renal transplantation? A case report.
World journal of transplantation, 12 (1).
pp. 15-20.
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Abstract
<h4>Background</h4>Post-transplant nephrotic syndrome (PTNS) in a renal allograft carries a 48% to 77% risk of graft failure at 5 years if proteinuria persists. PTNS can be due to either recurrence of native renal disease or <i>de novo</i> glomerular disease. Its prognosis depends upon the underlying pathophysiology. We describe a case of post-transplant membranous nephropathy (MN) that developed 3 mo after kidney transplant. The patient was properly evaluated for pathophysiology, which helped in the management of the case.<h4>Case summary</h4>This 22-year-old patient had chronic pyelonephritis. He received a living donor kidney, and human leukocyte antigen-DR (HLA-DR) mismatching was zero. PTNS was discovered at the follow-up visit 3 mo after the transplant. Graft histopathology was suggestive of MN. In the past antibody-mediated rejection (ABMR) might have been misinterpreted as <i>de novo</i> MN due to the lack of technologies available to make an accurate diagnosis. Some researchers have observed that HLA-DR is present on podocytes causing an anti-DR antibody deposition and development of <i>de novo</i> MN. They also reported poor prognosis in their series. Here, we excluded the secondary causes of MN. Immunohistochemistry was suggestive of IgG1 deposits that favoured the diagnosis of <i>de novo</i> MN. The patient responded well to an increase in the dose of tacrolimus and angiotensin converting enzyme inhibitor.<h4>Conclusion</h4>Exposure of hidden antigens on the podocytes in allografts may have led to subepithelial antibody deposition causing <i>de novo</i> MN.
| Item Type: | Article |
|---|---|
| Uncontrolled Keywords: | Alloimmunity, Case report, Cryptic antigens, Post-transplant nephrotic syndrome, Recurrent membranous nephropathy, Secondary membranous nephropathy |
| Divisions: | Faculty of Health and Life Sciences Faculty of Health and Life Sciences > Institute of Life Courses and Medical Sciences Faculty of Health and Life Sciences > Institute of Life Courses and Medical Sciences > School of Medicine |
| Depositing User: | Symplectic Admin |
| Date Deposited: | 08 Nov 2022 14:31 |
| Last Modified: | 17 Mar 2024 13:28 |
| DOI: | 10.5500/wjt.v12.i1.15 |
| Related URLs: | |
| URI: | https://livrepository.liverpool.ac.uk/id/eprint/3166052 |
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