The pathology and clinical features of early recurrent membranous glomerulonephritis

E. F. Rodriguez, F. G. Cosio, S. H. Nasr, S. Sethi, M. E. Fidler, M. D. Stegall, J. P. Grande, F. C. Fervenza, Lynn D. Cornell

Research output: Contribution to journalArticlepeer-review

49 Scopus citations


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 transplantswithout recurrentMGN. 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.

Original languageEnglish (US)
Pages (from-to)1029-1038
Number of pages10
JournalAmerican Journal of Transplantation
Issue number4
StatePublished - Apr 2012
Externally publishedYes


  • Immune complex glomerulonephritis
  • Membranous glomerulopathy
  • Membranous nephropathy
  • Recurrent disease
  • Transplant

ASJC Scopus subject areas

  • Immunology and Allergy
  • Transplantation
  • Pharmacology (medical)


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