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In search of an effective treatment for recurrent mesangiocapillary glomerulonephritis in the renal allograft
Author(s) -
Cai Michael MX,
Simpson Ian,
Mulley William R
Publication year - 2014
Publication title -
nephrology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.752
H-Index - 61
eISSN - 1440-1797
pISSN - 1320-5358
DOI - 10.1111/nep.12191
Subject(s) - medicine , rituximab , transplantation , cyclophosphamide , kidney transplantation , surgery , glomerulonephritis , disease , kidney , chemotherapy , lymphoma
In patients with end‐stage kidney disease ( ESKD ) secondary to mesangiocapillary glomerulonephritis ( MCGN ), recurrent disease post transplantation is a common cause of graft loss. We report a case of a 33‐year‐old female with ESKD due to idiopathic MCGN who developed recurrent disease in two consecutive renal allografts. Recurrent disease was diagnosed two months after receiving her primary transplant from a live related donor. Oral cyclophosphamide was initiated but discontinued after 10 months due to cystitis. This was followed by rapid deterioration in her renal function. Despite salvage therapy with rituximab, the graft was lost 2 years post transplantation. After 7 years on haemodialysis, the patient received a second graft from a deceased donor. Recurrent MCGN was once again diagnosed one year post transplantation. She was treated with plasma exchange and rituximab. Despite ongoing nephrotic range proteinuria, her graft function remained stable 2 years post transplantation. The optimal therapy for recurrent MCGN is unknown at this stage. It is hoped that a better understanding of its pathogenesis will enable the development of more effective and targeted therapies.