| Title | Pauci-immune and Immune Glomerular Lesions in Kidney Transplants for Systemic Lupus Erythematosus. | | Author(s) | Meehan SM, Chang A, Khurana A, Baliga R, Kadambi PV, Javaid B | | Institution | Section of Nephrology, University of Chicago, Chicago, Illinois; and Department of Medicine, Division of Nephrology, Stanford University School of Medicine, Stanford, California. | | Source | Clin J Am Soc Nephrol 2008 Jun 18. | | Abstract | BACKGROUND AND OBJECTIVES: Glomerular lesions in allografts in recipients with end-stage nephritis resulting from systemic lupus erythematosus (SLE) were examined to determine the spectrum of glomerular pathology in recurrent glomerulonephritis (GN).
DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: A total of 156 biopsy samples, from 49 serial allografts in 43 recipients with end-stage lupus nephritis, were examined by light microscopy, and by immunofluorescence and electron microscopy in selected cases. These were compared with control allografts (n = 35).
RESULTS: Glomerular lesions best explained by recurrent lupus nephritis were observed in 19 of 49 allografts (38.8%) in lupus recipients. Three categories of glomerulopathies were identified: 1) immune complex glomerulopathies, including mesangial GN (28%) and membranous GN (4%); 2) atypical glomerulopathies, including acute proliferative GN (32%) and focal segmental glomerulosclerosis (12%), with scant immune deposits in glomerular capillaries, frequent endothelial tubuloreticular inclusions, and thrombotic microangiopathy; and 3) transplant-associated glomerulopathies (24%).
CONCLUSIONS: Allografts from recipients with SLE had typical immune complex-mediated GN and atypical pauci-immune, proliferative GN and segmental glomerular sclerosis. Atypical glomerulopathies like these suggest a role for nonimmune complex-mediated glomerular injury in recurrent lupus GN. | | Language | ENG | | Pub Type(s) | JOURNAL ARTICLE
| | PubMed ID | 18562595 |
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