De novo glomerular diseases after renal transplantation:How is it different from recurrent glomerular diseases?

查看全文 作　　者：Fedaey [1,2]Abbas;Mohsen El [2,3]Kossi;Jon Kim [2,4]Jin;Ajay [2,5]Sharma;Ahmed [2,6]Halawa

机构地区：[1]Department of Nephrology,Jaber El Ahmed Military Hospital;[2]Faculty of Health and Science,University of Liverpool,Institute of Learning and Teaching,School of Medicine;[3]Doncaster Royal Infirmary;[4]Nottingham Children Hospital;[5]Royal Liverpool University Hospitals;[6]Department of Transplantation Surgery,Sheffield Teaching Hospitals

出　　处：《World Journal of Transplantation》索引2017年第7卷第6期,共16页

摘　　要：The glomerular diseases after renal transplantation can occur de novo,i.e.,with no relation to the native kidney disease,or more frequently occur as a recurrence of the original disease in the native kidney.There may not be any difference in clinical features and histological pattern between de novo glomerular disease and recurrence of original glomerular disease.However,structural alterations in transplanted kidney add to dilemma in diagnosis.These changes in architecture of histopathology can happen due to:(1) exposure to the immunosuppression specifically the calcineurin inhibitors(CNI);(2) in vascular and tubulointerstitial alterations as a result of antibody mediated or cellmediated immunological onslaught;(3) post-transplant viral infections;(4) ischemia-reperfusion injury; and(5) hyperfiltration injury.The pathogenesis of the de novo glomerular diseases differs with each type.Stimulation of B-cell clones with subsequent production of the monoclonal Ig G,particularly Ig G3 subtype that has higher affinity to the negatively charged glomerular tissue,is suggested to be included in PGNMID pathogenesis.De novo membranous nephropathy canbe seen after exposure to the cryptogenic podocyte antigens.The role of the toxic effects of CNI including tissue fibrosis and the hemodynamic alterations may be involved in the de novo FSGS pathophysiology.The well-known deleterious effects of HCV infection and its relation to MPGN disease are frequently reported.The new concepts have emerged that demonstrate the role of dysregulation of alternative complement pathway in evolution of MPGN that led to classifying into two subgroups,immune complex mediated MPGN and complement-mediated MPGN.The latter comprises of the dense deposit disease and the C3 GN disease.De novo C3 disease is rather rare.Prognosis of de novo diseases varies with each type and their management continues to be empirical to a large extent. 关键词：De novo GLOMERULONEPHRITIS RENAL TRANSPLANTATION New concepts of THERAPY

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De novo glomerular diseases after renal transplantation:How is it different from recurrent glomerular diseases?

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