Recurrent lupus nephritis after kidney transplantation: a surveillance biopsy study.
OBJECTIVE
To determine the incidence of recurrent lupus nephritis (LN) in renal transplant recipients with systemic lupus erythematosus (SLE).


METHODS
All patients with SLE that had undergone transplant with a functioning graft were asked in 2008 to participate in a cross-sectional study. The study included a standardised clinical examination, laboratory tests and a biopsy of the transplanted kidney.


RESULTS
A total of 41 (93%) of a cohort of 44 patients with SLE with renal transplants participated. Of the biopsies, 3 were indication biopsies and 38 were surveillance biopsies. In all, 22 patients (54%) had biopsy-proven recurrence of LN. The majority of the cases were subclinical and characterised as class I/class II LN. Proteinuria (mg protein/mmol creatinine) was significantly increased in patients with recurrence, 70.6 (104.9) mg/mmol versus 11.9 (6.7) mg/mmol in patients without recurrence (p=0.038). Lupus anticoagulant was found more frequently in the patients with recurrence, nine versus two patients (p=0.033). Recurrence of LN was associated with receiving a kidney from a living donor (p=0.049). In all, 83% (34 of 41) had chronic allograft nephropathy in the transplanted kidneys with no difference between patients with recurrence or without.


CONCLUSIONS
Subclinical recurrence of LN is common in patients with renal transplants with SLE. The majority of the patients have chronic allograft nephropathy.
Norby
Gudrun E
GE
Department of Rheumatology, Oslo University Hospital, Rikshospitalet, Sognsvannsveien 20, Oslo 0027, Norway. gudrun.elisabeth.norby@rikshospitalet.no
Strøm
Erik H
EH
Midtvedt
Karsten
K
Hartmann
Anders
A
Gilboe
Inge-Margrethe
IM
Leivestad
Torbjørn
T
Stenstrøm
Jean
J
Holdaas
Hallvard
H
D000328:Adult; D015415:Biomarkers / Q000097:blood; D001706:Biopsy; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D007165:Immunosuppression Therapy / Q000379:methods; D007668:Kidney / Q000473:pathology; D007676:Kidney Failure, Chronic / Q000209:etiology / Q000601:surgery*; D016030:Kidney Transplantation / Q000473:pathology*; D019520:Living Donors; D016682:Lupus Coagulation Inhibitor / Q000097:blood; D008181:Lupus Nephritis / Q000150:complications / Q000473:pathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011507:Proteinuria / Q000473:pathology; D012008:Recurrence; D012307:Risk Factors
D015415:Biomarkers; D016682:Lupus Coagulation Inhibitor