Is de novo membranous nephropathy suggestive of alloimmunity in renal transplantation?A case report

作     者：Prakash I Darji Himanshu A Patel Bhavya P Darji Ajay Sharma Ahmed Halaw 

作者机构：Department of Nephrology and Renal TransplantationZydus HospitalsAhmedabad 380059GujaratIndia InternshipDepartment of MedicineGCS Medical CollegeHospital and Research CentreAhmedabad 380025GujaratIndia Faculty of Health and Life ScienceInstitute of Learning and TeachingUniversity of LiverpoolLiverpool L693BXUnited Kingdom Consultant Transplant SurgeonRoyal Liverpool University HospitalsLiverpool L78XPUnited Kingdom Department of TransplantationSheffield Teaching HospitalsSheffield S102JFUnited Kingdom 

出 版 物：《World Journal of Transplantation》 (世界移植杂志)

年 卷 期：2022年第12卷第1期

页      面：15-20页

学科分类：1002[医学-临床医学] 100210[医学-外科学(含：普外、骨外、泌尿外、胸心外、神外、整形、烧伤、野战外)] 10[医学] 

主　　题：Post-transplant nephrotic syndrome Recurrent membranous nephropathy Secondary membranous nephropathy Alloimmunity Cryptic antigens Case report 

摘      要：BACKGROUND Post-transplant nephrotic syndrome(PTNS)in a renal allograft carries a 48%to 77%risk of graft failure at 5 years if proteinuria *** can be due to either recurrence of native renal disease or de novo glomerular *** prognosis depends upon the underlying *** describe a case of post-transplant membranous nephropathy(MN)that developed 3 mo after kidney *** patient was properly evaluated for pathophysiology,which helped in the management of the *** SUMMARY This 22-year-old patient had chronic *** received a living donor kidney,and human leukocyte antigen-DR(HLA-DR)mismatching was *** was discovered at the follow-up visit 3 mo after the *** histopathology was suggestive of *** the past antibody-mediated rejection(ABMR)might have been misinterpreted as de novo MN due to the lack of technologies available to make an accurate *** researchers have observed that HLA-DR is present on podocytes causing an anti-DR antibody deposition and development of de novo *** also reported poor prognosis in their ***,we excluded the secondary causes of *** was suggestive of IgG1 deposits that favoured the diagnosis of de novo *** patient responded well to an increase in the dose of tacrolimus and angiotensin converting enzyme *** Exposure of hidden antigens on the podocytes in allografts may have led to subepithelial antibody deposition causing de novo MN.