title: Non-immunoglobulin A mesangial immune complex glomerulonephritis in kidney transplants.
abstract: We have observed a predominantly mesangial non-immunoglobulin A immune complex mesangial glomerulopathy (MG) in renal transplants with mesangial deposits by immunofluorescence and electron microscopy. Clinicopathological features of 28 patients with MG were analyzed and compared with 28 transplant controls, matched for age, sex, ethnicity, donor type, estimated glomerular filtration rate, and interval from transplant to biopsy. Indications for biopsy in the MG group were allograft dysfunction in 64%, allograft dysfunction/proteinuria in 29%, and proteinuria in 7%. Biopsy indications in controls were allograft dysfunction (61%), allograft dysfunction/proteinuria (18%), proteinuria (14%), and delayed graft function (7%). Most MG cases had mild mesangial hypercellularity with endocapillary proliferation in 2 and crescents in 2 without fibrinoid necrosis. Immunoglobulin M-dominant deposits were present in 83%, and immunoglobulin G was dominant in 17% with mesangial deposits in 93% of cases by electron microscopy. Compared with controls, MG had higher Banff interstitial inflammation score (i) (P = .036) and was associated with concurrent acute T-cell-mediated rejection (P = .023), but not with acute or chronic antibody-mediated rejection. MG patients and controls had similar prevalence of polyomavirus nephropathy and Epstein-Barr virus infection. At follow-up, most MG patients had stable estimated glomerular filtration rate with no or stable proteinuria. Disease-specific graft survival was not different in MG versus controls. We conclude that, in view of the apparent self-limited nature of this lesion, additional treatment may not be required in these patients. Awareness of this lesion may thus spare patients unwarranted further intervention.
authors.affiliation: Department of Pathology, Microbiology and Immunology, Vanderbilt University Medical Center, Nashville, TN 37232. Electronic address: giovanna.giannico@vanderbilt.edu.
authors.forename: Giovanna A
authors.initials: GA
authors.lastname: Giannico
authors.affiliation: Department of Pathology, Microbiology and Immunology, Vanderbilt University Medical Center, Nashville, TN 37232; Department of Veterans Affairs, Nashville, TN 37212. Electronic address: Shanna.arnold@vanderbilt.edu.
authors.forename: Shanna
authors.initials: S
authors.lastname: Arnold
authors.affiliation: Division of Kidney and Pancreas Transplantation, Vanderbilt University Medical Center, Nashville, TN 37232. Electronic address: anthony.langone@vanderbilt.edu.
authors.forename: Anthony
authors.initials: A
authors.lastname: Langone
authors.affiliation: Division of Kidney and Pancreas Transplantation, Vanderbilt University Medical Center, Nashville, TN 37232. Electronic address: heidi.schaefer@vanderbilt.edu.
authors.forename: Heidi
authors.initials: H
authors.lastname: Schaefer
authors.affiliation: Division of Kidney and Pancreas Transplantation, Vanderbilt University Medical Center, Nashville, TN 37232. Electronic address: hal.helderman@vanderbilt.edu.
authors.forename: J Harold
authors.initials: JH
authors.lastname: Helderman
authors.affiliation: Division of Kidney and Pancreas Transplantation, Vanderbilt University Medical Center, Nashville, TN 37232. Electronic address: david.shaffer@vanderbilt.edu.
authors.forename: David
authors.initials: D
authors.lastname: Shaffer
authors.affiliation: Department of Pathology, Microbiology and Immunology, Vanderbilt University Medical Center, Nashville, TN 37232. Electronic address: agnes.fogo@vanderbilt.edu.
authors.forename: Agnes B
authors.initials: AB
authors.lastname: Fogo
mesh_terms: D000293:Adolescent; D000328:Adult; D064591:Allografts; D002648:Child; D005260:Female; D005455:Fluorescent Antibody Technique; D005920:Glomerular Mesangium / Q000473:pathology; D005921:Glomerulonephritis / Q000453:epidemiology / Q000209:etiology / Q000473:pathology*; D006801:Humans; D007105:Immune Complex Diseases / Q000453:epidemiology / Q000209:etiology / Q000473:pathology*; D016030:Kidney Transplantation / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D055815:Young Adult
keywords: Immune complex glomerulonephritis; Mesangial glomerulonephritis; Renal biopsy; Transplant biopsy; Transplant glomerulonephritis