Division of Nephrology, Scientific Institute Humanitas, Milan, Italy.
Clin J Am Soc Nephrol. 2010 Dec;5(12):2363-72. doi: 10.2215/CJN.06720810. Epub 2010 Oct 28.
All forms of primary GN may recur after kidney transplantation and potentially jeopardize the survival of the graft. IgA nephritis (IgAN) may recur in approximately one third of patients, more frequently in younger patients and in those with a rapid progression of the original disease. However, with the exception of few patients with rapid progression, there is no evidence that recurrence of IgAN has a deleterious effect on graft survival at least up to 10 years. Recurrence of focal segmental glomerulosclerosis (FSGS) is often associated with nephrotic proteinuria and is more frequent in children, in patients with rapid progression of the original disease, and in those who lost a previous transplant from recurrence. The natural course of recurrent FSGS is usually unfavorable. Early and intensive plasmapheresis may obtain complete or partial response in several patients. Good results have also been reported with rituximab. Idiopathic membranous nephropathy (IMN) may recur in 30% to 40% of patients. The graft survival in patients with IMN is not different than that of patients with other renal diseases. Good results with rituximab have been reported. Membranoproliferative GN (MPGN) may recur in 27% to 65% of patients. The recurrence is more frequent and the prognosis is more severe in type II MPGN. Although recurrent GN is relatively frequent and may worsen the outcome of renal allografts in some patients, its effect is diluted by several other risk-factors that may have a greater effect than recurrent GN on the long-term graft survival.
所有类型的原发性肾小球肾炎（GN）在肾移植后都可能复发，并有可能危及移植物的存活。IgA 肾病（IgAN）约有三分之一的患者会复发，在年轻患者和原发病进展较快的患者中更为常见。然而，除了少数进展迅速的患者外，没有证据表明 IgAN 复发对移植物存活至少在 10 年内有不良影响。局灶节段性肾小球硬化症（FSGS）的复发常伴有肾病性蛋白尿，且更常见于儿童、原发病进展迅速的患者和因复发而失去前一个移植物的患者。复发性 FSGS 的自然病程通常不利。早期和强化血浆置换可能会使一些患者获得完全或部分缓解。利妥昔单抗也有良好的效果报告。特发性膜性肾病（IMN）在 30%至 40%的患者中会复发。IMN 患者的移植物存活率与其他肾脏疾病患者无差异。利妥昔单抗有良好的效果报告。膜增殖性肾小球肾炎（MPGN）在 27%至 65%的患者中会复发。II 型 MPGN 的复发更为频繁，预后更为严重。虽然复发性 GN 较为常见，并且在某些患者中可能会使肾移植的预后恶化，但它的影响被其他一些可能对长期移植物存活率有更大影响的风险因素所稀释。
