Membranous Nephropathy (MN) Recurrence After Renal Transplantation
| Autor: | Federica Tripodi, Silvia Malvica, Roberta Cerutti, Piergiorgio Messa, Patrizia Passerini |
|---|---|
| Jazyk: | angličtina |
| Rok vydání: | 2019 |
| Předmět: |
Male
kidney transplant lcsh:Immunologic diseases. Allergy 0301 basic medicine medicine.medical_specialty Immunology Autoimmunity Review Antigen-Antibody Complex Disease Glomerulonephritis Membranous Gastroenterology Autoimmune Diseases 03 medical and health sciences rituximab 0302 clinical medicine Membranous nephropathy Recurrence Internal medicine Glomerular Basement Membrane Biopsy medicine Humans Immunology and Allergy Kidney transplantation Proteinuria medicine.diagnostic_test business.industry membranous nephropathy medicine.disease Kidney Transplantation Transplantation Seminiferous Epithelium 030104 developmental biology Rituximab prognosis recurrent membranous nephropathy proteinuria medicine.symptom lcsh:RC581-607 business Nephrotic syndrome anti-PLA2R antibodies 030215 immunology medicine.drug |
| Zdroj: | Frontiers in Immunology, Vol 10 (2019) Frontiers in Immunology |
| ISSN: | 1664-3224 |
| DOI: | 10.3389/fimmu.2019.01326 |
| Popis: | Primary membranous nephropathy (MN) is a frequent cause of NS in adults. In native kidneys the disease may progress to ESRD in the long term, in some 40–50% of untreated patients. The identification of the pathogenic role of anti-podocyte autoantibodies and the development of new therapeutic options has achieved an amelioration in the prognosis of this disease. MN may also develop in renal allograft as a recurrent or a de novo disease. Since the de novo MN may have some different pathogenetic and morphologic features compared to recurrent MN, in the present paper we will deal only with the recurrent disease. The true incidence of the recurrent form is difficult to assess. This is mainly due to the variable graft biopsy policies in kidney transplantation, among the different transplant centers. Anti-phospholipase A2 receptor (PLA2R) autoantibodies are detected in 70–80% of patients. The knowledge of anti-PLA2R status before transplant is useful in predicting the risk of recurrence. In addition, the serial survey of the anti-PLA2R titers is important to assess the rate of disease progression and the response to treatment. Currently, there are no established guidelines for prevention and treatment of recurrent MN. Symptomatic therapy may help to reduce the signs and symptoms related to the nephrotic syndrome. Anecdotal cases of response to cyclical therapy with steroids and cyclophosphamide have been published. Promising results have been reported with rituximab in both prophylaxis and treatment of recurrence. However, these results are based on observational data, and prospective controlled trials are still missing. |
| Databáze: | OpenAIRE |
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