Recurrent and de novo glomerulonephritis in allografted kidneys: aspects of ultrastructural diagnosis.
Allograft glomerulonephritis (GN) is a noteworthy alternative in the differential diagnosis of renal graft dysfunction. The true frequency of allograft GN is unknown; a rough estimate is 5-15%. The highest rates of recurrence (100-20%) have been reported, in decreasing order of frequency, in mesangiocapillary GN (MCGN) type 2, IgA nephropathy, MCGN type 1, and focal segmental glomerulosclerosis (FSGS). In addition, in about 2% of allografts membranous GN (MGN) occurs as a de novo lesion. Electron microscopy has proved valuable in detecting early or mild MGN, MCGN type 2 and FSGS, and in differentiating between MCGN type 1 and allograft (rejection) glomerulopathy. Even with the aid of electron microscopy, however, the demarcation between MCGN type 1 and allograft glomerulopathy may prove impossible. The finding of prominent mesangial deposits (in an otherwise normal allograft), is highly suggestive of recurrent IgA nephropathy.
Törnroth
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Fourth Department of Medicine, Helsinki University Central Hospital, Finland.
D005921:Glomerulonephritis / Q000145:classification / Q000473:pathology*; D005922:Glomerulonephritis, IGA / Q000473:pathology; D005923:Glomerulosclerosis, Focal Segmental / Q000473:pathology; D006801:Humans; D007668:Kidney / Q000648:ultrastructure; D016030:Kidney Transplantation; D008566:Membranes / Q000473:pathology; D008854:Microscopy, Electron; D011183:Postoperative Complications / Q000473:pathology*