Pauci-immune and immune glomerular lesions in kidney transplants for systemic lupus erythematosus.
OBJECTIVE
Glomerular lesions in allografts in recipients with end-stage nephritis resulting from systemic lupus erythematosus (SLE) were examined to determine the spectrum of glomerular pathology in recurrent glomerulonephritis (GN).


METHODS
A total of 156 biopsy samples, from 49 serial allografts in 43 recipients with end-stage lupus nephritis, were examined by light microscopy, and by immunofluorescence and electron microscopy in selected cases. These were compared with control allografts (n = 35).


RESULTS
Glomerular lesions best explained by recurrent lupus nephritis were observed in 19 of 49 allografts (38.8%) in lupus recipients. Three categories of glomerulopathies were identified: 1) immune complex glomerulopathies, including mesangial GN (28%) and membranous GN (4%); 2) atypical glomerulopathies, including acute proliferative GN (32%) and focal segmental glomerulosclerosis (12%), with scant immune deposits in glomerular capillaries, frequent endothelial tubuloreticular inclusions, and thrombotic microangiopathy; and 3) transplant-associated glomerulopathies (24%).


CONCLUSIONS
Allografts from recipients with SLE had typical immune complex-mediated GN and atypical pauci-immune, proliferative GN and segmental glomerular sclerosis. Atypical glomerulopathies like these suggest a role for nonimmune complex-mediated glomerular injury in recurrent lupus GN.
Department of Pathology, Section of Nephrology, University of Chicago, Chicago, Illinois 60637, USA. shane.meehan@uchospitals.edu
Shane M
SM
Meehan
Anthony
A
Chang
Amandeep
A
Khurana
Rajendra
R
Baliga
Pradeep V
PV
Kadambi
Basit
B
Javaid
D000328:Adult; D000936:Antigen-Antibody Complex / Q000032:analysis; D005260:Female; D015432:Glomerulonephritis, Membranoproliferative / Q000276:immunology* / Q000473:pathology; D015433:Glomerulonephritis, Membranous / Q000276:immunology* / Q000473:pathology; D005923:Glomerulosclerosis, Focal Segmental / Q000276:immunology* / Q000473:pathology; D006084:Graft Rejection / Q000276:immunology / Q000473:pathology; D006085:Graft Survival; D006801:Humans; D016030:Kidney Transplantation / Q000009:adverse effects*; D008180:Lupus Erythematosus, Systemic / Q000150:complications / Q000276:immunology / Q000473:pathology / Q000601:surgery*; D008181:Lupus Nephritis / Q000276:immunology / Q000473:pathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D012008:Recurrence; D012189:Retrospective Studies; D013997:Time Factors; D014184:Transplantation, Homologous
D000936:Antigen-Antibody Complex