DE NOVO AND RECURRENT MEMBRANOUS GLOMERULOPATHY FOLLOWING KIDNEY TRANSPLANTATION
DE NOVO AND RECURRENT MEMBRANOUS GLOMERULOPATHY FOLLOWING KIDNEY TRANSPLANTATION
复制标题
肾移植后的新发和复发性膜性肾小球病
作者：
B. Berger;F. Vincenti;C. Biava;W. Amend;N. Feduska;O. Salvatierra
膜性肾小球病，新发或复发，在移植肾是一个公认的，虽然罕见，临床实体。我们检查了936例肾移植受者在七年半的时间内的记录。新发膜性肾小球病6例。移植后肾病范围蛋白尿的平均发病时间为18.1个月（范围为4至30个月）。原发性膜性肾小球病对移植物存活率无不良影响。25例患者因膜性肾小球病引起的终末期肾病接受移植。在移植后即刻没有因排斥而失去移植物的患者中，膜性肾小球病的复发率为7%。在标准免疫抑制方案的基础上加用泼尼松治疗似乎没有益处。一名患者，谁开发了复发的原始病变，收到了HLA相同的肾脏。肾移植后4周出现肾病范围蛋白尿。在另外5名患者中报告了复发性膜性肾小球病。在两个受体的生活相关的同种异体移植肾蛋白尿的范围内发展的两个星期的移植。患有由膜性肾小球病引起的终末期肾病的患者接受活体相关的同种异体移植物，特别是HLA相同的同种异体移植物，可能具有较高的发病率和早期复发风险。我们建议对膜性肾小球病引起的终末期肾病患者谨慎使用活体亲属移植。
Membranous glomerulopathy, de novo or recurrent, in the allograft kidney is a recognized, albeit uncommon, clinical entity. We examined the records of 936 renal allograft recipients in a seven and one-half year period. De novo membranous glomerulopathy developed in six patients. The mean onset of nephrotic-range proteinuria after transplantation was at 18.1 months (with a range of from 4 to 30 months). De novo membranous glomerulopathy did not adversely affect graft survival. Twenty-five patients were transplanted for end-stage renal disease caused by membranous glomerulopathy. The rate of recurrence of membranous glomerulopathy in patients who did not lose their allograft to rejection in the immediate posttransplant period was 7%. Additional prednisone therapy to the standard immunosuppressive protocol did not appear to be beneficial. One patient, who developed a recurrence of the original lesion, received an HLA-identical kidney. Onset of nephrotic-range proteinuria occurred four weeks post-transplant. Recurrent membranous glomerulopathy has been reported in five other patients. In the two recipients of living related allografts nephrotic-range proteinuria developed within two weeks of the transplant. Patients with end-stage renal disease caused by membranous glomerulopathy who receive a living related allograft, especially one that is HLA-identical, may be at a higher risk for morbidity and for early recurrence. We recommend caution in the use of a living related transplant for patients with end-stage renal disease caused by membranous glomerulopathy.