Christopher D Blosser1, Roy D Bloom. 1. aDepartment of Medicine, Division of Nephrology, University of Washington, Washington bDepartment of Medicine, Renal Division, University of Pennsylvania cDepartment of Medicine, Penn Transplant Institute, Pennsylvania, USA.
Abstract
PURPOSE OF REVIEW: With improving short-term kidney transplant outcomes, recurrent glomerular disease is being increasingly recognized as an important cause of chronic allograft failure. Further understanding of the risks and pathogenesis of recurrent glomerular disease enable informed transplant decisions, along with the development of preventive and treatment strategies. RECENT FINDINGS: Multiple observational studies have highlighted differences in rates and outcomes for various recurrent glomerular diseases, although these rates have not markedly improved over the last decade. Emerging evidence supports use of rituximab to treat recurrent primary membranous nephropathy and possibly focal segmental glomerulosclerosis (FSGS), whereas eculizumab is effective in glomerular diseases associated with complement dysregulation [C3 glomerulopathy (C3G) and atypical hemolytic uremic syndrome (aHUS)]. SUMMARY: Despite the potential for recurrence in the allograft, transplant remains the optimal therapy for patients with advanced chronic kidney disease (CKD) secondary to primary glomerular disease. Biomarkers and therapeutic options necessitate accurate pretransplant diagnoses with opportunities for improved surveillance and treatment of recurrent glomerular disease posttransplant.
PURPOSE OF REVIEW: With improving short-term kidney transplant outcomes, recurrent glomerular disease is being increasingly recognized as an important cause of chronic allograft failure. Further understanding of the risks and pathogenesis of recurrent glomerular disease enable informed transplant decisions, along with the development of preventive and treatment strategies. RECENT FINDINGS: Multiple observational studies have highlighted differences in rates and outcomes for various recurrent glomerular diseases, although these rates have not markedly improved over the last decade. Emerging evidence supports use of rituximab to treat recurrent primary membranous nephropathy and possibly focal segmental glomerulosclerosis (FSGS), whereas eculizumab is effective in glomerular diseases associated with complement dysregulation [C3 glomerulopathy (C3G) and atypical hemolytic uremic syndrome (aHUS)]. SUMMARY: Despite the potential for recurrence in the allograft, transplant remains the optimal therapy for patients with advanced chronic kidney disease (CKD) secondary to primary glomerular disease. Biomarkers and therapeutic options necessitate accurate pretransplant diagnoses with opportunities for improved surveillance and treatment of recurrent glomerular disease posttransplant.
Authors: Erin K Stenson; Zhiying You; Ron Reeder; Jesse Norris; Halden F Scott; Bradley P Dixon; Joshua M Thurman; Ashley Frazer-Abel; Peter Mourani; Jessica Kendrick Journal: Kidney360 Date: 2021-10-07
Authors: Audrey Uffing; Maria José Pérez-Sáez; Gaetano La Manna; Giorgia Comai; Clara Fischman; Samira Farouk; Roberto Ceratti Manfro; Andrea Carla Bauer; Bruno Lichtenfels; Juliana B Mansur; Hélio Tedesco-Silva; Gianna M Kirsztajn; Anna Manonelles; Oriol Bestard; Miguel Carlos Riella; Silvia Regina Hokazono; Carlos Arias-Cabrales; Elias David-Neto; Carlucci Gualberto Ventura; Enver Akalin; Omar Mohammed; Eliyahu V Khankin; Kassem Safa; Paolo Malvezzi; Michelle Marie O'Shaughnessy; Xingxing S Cheng; Paolo Cravedi; Leonardo V Riella Journal: BMC Nephrol Date: 2018-09-12 Impact factor: 2.388