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Pathology of recurrent diseases in kidney allografts: membranous nephropathy and focal segmental glomerulosclerosis

Kowalewska, Jolanta

Current Opinion in Organ Transplantation: June 2013 - Volume 18 - Issue 3 - p 313–318
doi: 10.1097/MOT.0b013e3283614ab5
PATHOLOGY: Edited by Michael Mengel

Purpose of review Glomerulonephritis is the leading cause of end-stage renal failure in renal transplant recipients. Recurrence of diseases in kidney allograft provides a unique opportunity to study the mechanisms of kidney disorders leading to the underlying native organ failure. There have been new advances in the understanding of the mechanisms of membranous nephropathy and focal segmental glomerulosclerosis (FSGS).

Recent findings Recent studies of recurrent membranous nephropathy provide evidence of the presence of circulating recipient factor that targets the donor kidney and put forward the evidence of antiphospholipase A2 receptor antibody pathogenicity in some cases, point to a different pathogenesis of recurrent and de-novo membranous nephropathy, and stress the importance of early morphologic recognition of recurrent membranous nephropathy. New advances in understanding the FSGS include identification of soluble podocyte urokinase receptor as a circulating factor leading to the development and recurrence of FSGS after transplantation, imply that podocyte injury may be a reversible lesion, and suggest a dual role of activated parietal epithelial cells in sclerosing glomerular injury as well as in regeneration and repair.

Summary Several new mechanisms of glomerular injury have been implicated in the development of recurrent kidney diseases. When further confirmed, some of these might result in early diagnosis and development of better therapy of the respective disorders.

Department of Pathology, Medical University of Bialystok, Bialystok, Poland

Correspondence to Jolanta Kowalewska, Department of Pathology, Medical University of Bialystok, Waszyngtona 13, 15-269 Bialystok, Poland. Tel: +48 85 748 5945; fax: +48 85 748 5990; e-mail:

© 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins