title: Phospholipase A2 receptor positive membranous nephropathy long after living donor kidney transplantation between identical twins.
abstract: Although membranous nephropathy (MN) is a commonly observed cause of post-transplant glomerulonephritis, distinguishing de novo from recurrent MN in kidney allograft is often difficult. Phospholipase A2 receptor (PLA2R) staining is useful for diagnosing recurrent MN in allografts similarly to idiopathic MN in native kidney. No specific treatment strategy has been established for MN, especially when accompanied with HCV infection in kidney transplant recipients. This report describes a 66-year-old man who was diagnosed as having PLA2R positive membranous nephropathy accompanied with already-known IgA nephropathy and HCV infection 26 years after kidney transplantation conducted between identical twins. PLA2R was detected along capillary loops, implying that this patient is affected by the same pathogenic mechanism as idiopathic MN, not secondary MN associated with other disorders such as HCV infection. The patient successfully achieved clinical remission after steroid therapy.
authors.affiliation: Division of Nephrology and Endocrinology, The University of Tokyo, Tokyo, Japan.
authors.forename: Hisako
authors.initials: H
authors.lastname: Saito
authors.affiliation: Division of Nephrology and Endocrinology, The University of Tokyo, Tokyo, Japan.
authors.forename: Yoshifumi
authors.initials: Y
authors.lastname: Hamasaki
authors.affiliation: Division of Nephrology and Endocrinology, The University of Tokyo, Tokyo, Japan.
authors.forename: Akihiro
authors.initials: A
authors.lastname: Tojo
authors.affiliation: Department of Pathology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.
authors.forename: Yukako
authors.initials: Y
authors.lastname: Shintani
authors.affiliation: Department of Analytic Human Pathology, Nippon Medical School, Tokyo, Japan.
authors.forename: Akira
authors.initials: A
authors.lastname: Shimizu
authors.affiliation: Division of Nephrology and Endocrinology, The University of Tokyo, Tokyo, Japan.
authors.forename: Masaomi
authors.initials: M
authors.lastname: Nangaku
mesh_terms: D000328:Adult; D000368:Aged; D064591:Allografts; D015415:Biomarkers / Q000032:analysis; D001706:Biopsy; D004200:Diseases in Twins; D005455:Fluorescent Antibody Technique; D005922:Glomerulonephritis, IGA / Q000276:immunology; D015433:Glomerulonephritis, Membranous / Q000175:diagnosis / Q000188:drug therapy / Q000209:etiology* / Q000276:immunology / Q000378:metabolism; D006526:Hepatitis C / Q000276:immunology; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D007668:Kidney / Q000737:chemistry* / Q000187:drug effects / Q000276:immunology / Q000648:ultrastructure; D007676:Kidney Failure, Chronic / Q000175:diagnosis / Q000276:immunology / Q000601:surgery*; D016030:Kidney Transplantation / Q000009:adverse effects* / Q000379:methods; D019520:Living Donors; D008297:Male; D008854:Microscopy, Electron; D009404:Nephrotic Syndrome / Q000209:etiology; D054507:Receptors, Phospholipase A2 / Q000032:analysis*; D012074:Remission Induction; D013256:Steroids / Q000627:therapeutic use; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D015415:Biomarkers; D007166:Immunosuppressive Agents; C516360:PLA2R1 protein, human; D054507:Receptors, Phospholipase A2; D013256:Steroids
keywords: HCV infection; kidney transplantation; membranous nephropathy; phospholipase A2 receptor; steroid therapy