Recurrence of anti-GBM disease 8 years after renal transplantation

Anti-glomerular basement membrane (GBM) disease is a disorder characterized by antibodies against an epitope of type IV collagen found on the GBM. The major clinical sequela is rapidly progressive glomerulonephritis, which may be accompanied by pulmonary haemorrhage (Goodpasture’s syndrome). Glomerulonephritis secondary to anti-GBM disease frequently progresses to end-stage renal disease (ESRD) in the subset of patients who present with markedly impaired renal function. Renal transplantation is performed for ESRD due to anti-GBM disease, although most centres delay transplantation until patients are anti-GBM antibody negative for at least 12 months. Although early case series showed frequent recurrence in the allograft [1], modern therapeutic approaches have made recurrent disease very rare, and only four cases have been reported [2–5]. The effect of therapy for recurrent allograft disease is not well described. We report a case of recurrent anti-GBM disease in a renal allograft with successful salvage of the allograft.