Copyright ©The Author(s) 2017. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Transplant. Dec 24, 2017; 7(6): 285-300
Published online Dec 24, 2017. doi: 10.5500/wjt.v7.i6.285
De novo glomerular diseases after renal transplantation: How is it different from recurrent glomerular diseases?
Fedaey Abbas, Mohsen El Kossi, Jon Kim Jin, Ajay Sharma, Ahmed Halawa
Fedaey Abbas, Department of Nephrology, Jaber El Ahmed Military Hospital, Safat 13005, Kuwait
Fedaey Abbas, Mohsen El Kossi, Jon Kim Jin, Ajay Sharma, Ahmed Halawa, Faculty of Health and Science, University of Liverpool, Institute of Learning and Teaching, School of Medicine, Liverpool L69 3GB, United Kingdom
Mohsen El Kossi, Doncaster Royal Infirmary, Doncaster DN2 5LT, United Kingdom
Jon Kim Jin, Nottingham Children Hospital, Nottingham NG7 2UH, United Kingdom
Ajay Sharma, Royal Liverpool University Hospitals, Liverpool L7 8XP, United Kingdom
Ahmed Halawa, Department of Transplantation Surgery, Sheffield Teaching Hospitals, Sheffield S5 7AU, United Kingdom
Author contributions: Abbas F designed the study, data collection, writing the manuscript; El Kossi M, Jin JK and Sharma A reviewed and edited the manuscript; Halawa A contributed to conceptualization, designing the study, supervising the data collection and reviewing and editing the manuscript.
Conflict-of-interest statement: No conflict of interest.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
Correspondence to: Ahmed Halawa, FRCS (Gen Surg), MD, MSc, Surgeon, Consultant Transplant Surgeon, Department of Transplantation Surgery, Sheffield Teaching Hospitals, Herries Road, Sheffield S5 7AU, United Kingdom.
Telephone: +44-77-87542128 Fax: +44-11-42714604
Received: September 12, 2017
Peer-review started: September 15, 2017
First decision: October 24, 2017
Revised: November 2, 2017
Accepted: November 10, 2017
Article in press: November 10, 2017
Published online: December 24, 2017

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 cell-mediated 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 IgG, particularly IgG3 subtype that has higher affinity to the negatively charged glomerular tissue, is suggested to be included in PGNMID pathogenesis. De novo membranous nephropathy can be 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.

Keywords: De novo glomerulonephritis, Renal transplantation, New concepts of therapy

Core tip: The role of post-transplant glomerulonephritis in affecting both patient and allograft survival is well documented. For decades recurrent glomerular diseases after renal transplantation have been thoroughly investigated. On the other hand a group of a newly classified de novo glomerular diseases attained an increasing interest. However, the paucity of data concerned with de novo glomerular diseases after renal transplantation have been shown to be a great obstacle necessitating more active cooperation between transplant centers. A thorough work up is clearly warranted to declare not only their pathogenesis, but also to draw the proper therapeutic plan.