Recurrent Glomerulonephritis after Renal Transplantation

The most frequent cause of recurrent disease after renal transplantation is recurrent glomerulonephritis. The risk factors for recurrence of glomerulonephritis are largely unknown or imprecise and prediction remains difficult. Among the recurrent glomerulonephritides, type II membranoproliferative glomerulonephritis, immunoglobulin A nephropathy, and focal and segmental glomerulosclerosis have the highest rates of recurrence. Recurrent disease usually presents with similar manifestations as the native disease. With regard to treatment of recurrent glomerular disease in the renal allograft, plasma exchange may be effective in reducing proteinuria in patients with early recurrence of focal and segmental glomerulosclerosis, but immunosuppressive therapy is generally ineffective in the prevention or treatment of recurrent disease. General supportive measures including strict blood pressure control and inhibition or blockade of the renin-angiotensin pathway are helpful in retarding the rate of deterioration in renal allograft function. Despite the risk of recurrence, kidney transplantation following primary glomerulonephritides enjoys graft and patient survival rates comparable to other causes of end-stage renal failure. With a few exceptions, living related renal transplantation is not contraindicated in view of the favorable outcome and the donor shortage. In this mini review we tried to discuss commonly encountered recurrent glomerulonephritides after renal transplantation