Poduval Rajiv D, Josephson Michelle A, Javaid Basit
Department of Medicine, Section of Nephrology, University of Chicago, Pritzker School of Medicine, IL 60637, USA.
Semin Nephrol. 2003 Jul;23(4):392-9. doi: 10.1016/s0270-9295(03)00057-3.
Membranous nephropathy (MN) is one of the common glomerular diseases diagnosed in transplanted kidneys. The exact impact of posttransplantation MN on the risk for graft loss and long-term graft outcome is not defined clearly. In recent reports, it has emerged as the third most frequent glomerulonephritis (de novo or recurrent) associated with renal allograft loss. Most cases of posttransplantation MN are thought to be idiopathic but cases associated with established secondary causes also have been reported. Patients can present with varying degrees of proteinuria and graft dysfunction. Risk factors that predict a poor outcome are not well established and unlike MN in the native kidneys, spontaneous remission is rare. Patients should be evaluated carefully for complications associated with nephrotic syndrome or graft dysfunction and managed accordingly. The beneficial effects of steroids, cyclosporine, mycophenolate mofetil, cyclophosphamide, chlorambucil, or other agents have not been validated. The role of specific treatments in cases of secondary MN is uncertain. Retransplantation is a reasonable option for patients who develop graft failure secondary to MN.
膜性肾病（MN）是移植肾中常见的肾小球疾病之一。移植后MN对移植肾丢失风险和长期移植肾结局的确切影响尚不清楚。在最近的报告中，它已成为与肾移植丢失相关的第三常见的肾小球肾炎（新发或复发）。大多数移植后MN病例被认为是特发性的，但也有与已确定的继发原因相关的病例报道。患者可出现不同程度的蛋白尿和移植肾功能障碍。预测不良结局的危险因素尚未明确确立，与原发性肾脏的MN不同，自发缓解很少见。应仔细评估患者是否存在与肾病综合征或移植肾功能障碍相关的并发症，并相应地进行处理。类固醇、环孢素、霉酚酸酯、环磷酰胺、苯丁酸氮芥或其他药物的有益效果尚未得到证实。特异性治疗在继发性MN病例中的作用尚不确定。对于因MN导致移植肾失败的患者，再次移植是一个合理的选择。
