Marcen R, Mampaso F, Teruel J L, Rivera M E, Orofino L, Navarro-Antolin J, Ortuño J
Department of Nephrology, Hospital Ramón y Cajal, Madrid, Spain.
Nephrol Dial Transplant. 1996 Jun;11(6):1129-33.
It is supposed that about 5% of dialysis patients had membranous nephropathy as a cause for their renal failure. Despite of this prevalence, only 33 cases of recurrent membranous nephropathy after kidney transplantation have been reported in the English literature.
Among 509 recipients of renal allografts, membranous glomerulonephritis was the cause of renal failure in five patients, who received six transplants.
Recurrence of the disease was observed in three allografts (50%) in three patients, all of them were on treatment with cyclosporin and low-dose prednisone. Proteinuria appeared at 2, 5 and 19 months after grafting. One patient experienced a spontaneous remission after 12 months and he is free from proteinuria and with good renal function after 5 years. The remaining two patients presented progressive renal function deterioration and returned to haemodialysis 24 and 17 months after th appearance of proteinuria. In these patients increasing the immunosuppression did not produce any beneficial effect. One of those patients underwent a second transplant; recurrence of the membranous nephropathy has not been observed after 3 years of follow-up.
In this study three new cases of recurrence of membranous nephropathy are reported. One patient experienced a spontaneous remission of proteinuria. Recurrence of membranous nephropathy in renal allograft was very high in our series. Its appearance was associated with poor prognosis of the graft in most patients, although spontaneous remission of proteinuria is possible.
据推测，约5%的透析患者患有膜性肾病，这是其肾衰竭的病因。尽管有这样的患病率，但英文文献中仅报道了33例肾移植后复发性膜性肾病的病例。
在509例肾移植受者中，5例患者因膜性肾小球肾炎导致肾衰竭，共接受了6次移植。
3例患者的3个移植肾（50%）出现疾病复发，他们均接受环孢素和小剂量泼尼松治疗。蛋白尿分别在移植后2个月、5个月和19个月出现。1例患者在12个月后出现自发缓解，5年后无蛋白尿且肾功能良好。其余2例患者肾功能呈进行性恶化，在出现蛋白尿后24个月和17个月重新开始血液透析。在这些患者中，增加免疫抑制并未产生任何有益效果。其中1例患者接受了第二次移植；随访3年后未观察到膜性肾病复发。
本研究报告了3例新的膜性肾病复发病例。1例患者蛋白尿自发缓解。在我们的系列研究中，肾移植中膜性肾病的复发率很高。尽管蛋白尿可能自发缓解，但在大多数患者中，其出现与移植肾预后不良相关。
