Immune complex membranoproliferative glomerulonephritis in a kidney transplant recipient: diagnostic and therapeutic challenge

Authors

Mostafa, Mohamed; Fayyad, Zohair; AbdelTawab, Khaled; AlAwady, Medhat; Abdelmoneem, Mohamed; Altaleb, Ahmed; Alotaibi, Torki; Shaker, Mohamed; Gheith, Osama

Citation

Arab J Nephrol Transplant. 2026;8(2):81–86. doi: 10.4103/AJNT.AJNT_12_25

Abstract

In the context of a renal allograft, the occurrence of membranoproliferative glomerulonephritis (MPGN) represents a significant clinical challenge, signifying a substantial risk of allograft dysfunction and loss. We aimed to present a case of MPGN in a kidney transplant recipient with its diagnostic and therapeutic challenge. We report a case of a 62-year-old woman with recurrent glomerular disease following kidney transplantation, initially diagnosed – before transplant – as C3 glomerulopathy (C3G) secondary to a paraprotein. Her clinical course illustrates the diagnostic and pathophysiologic overlap between C3G and immune complex (IC)-mediated MPGN, highlighting the evolving nature of complement-mediated kidney injury in the setting of monoclonal gammopathy. This case highlights the diagnostic complexity of complement-mediated glomerulonephritis in the setting of monoclonal gammopathy. The transformation from C3G (before transplantation) to C1q-positive IC-MPGN posttransplant highlights the continuum of complement and IC activation pathways. Long-term follow-up with serial histopathologic evaluation and hematologic correlation is crucial to guide prognosis and management.

Full text (excerpt)

Immune complex membranoproliferative glomerulonephritis in a kidney transplant recipient: diagnostic and therapeutic challenge Mohamed Mostafaª, Zohair Fayyadª, Khaled AbdelTawabª, Medhat AlAwadyª, Mohamed Abdelmoneemª, Ahmed Altalebº, Torki Alotaibiº, Mohamed Shakerª, Osama Gheithª,c ªHamed Al-Essa Organ Transplant Center, bHistopathology Division, Faculty of Medicine, Kuwait, Urology and Nephrology Center, Mansoura University, Egypt Correspondence to Osama Gheith, MD, PhD, Consultant of Internal Medicine and Nephrology, Urology and Nephrology Center, Mansoura University, Egypt; Nephrology Department, Hamed Al-Essa Organ Transplant Center, Kuwait Tel: +20 1005138811; e-mail: [email protected] Received 14 November 2023 Revised 21 December 2023 Accepted 27 December 2023 Published 22 April 2024 Arab Journal of Nephrology and Transplantation 2026, 8:81-86 In the context of a renal allograft, the occurrence of membranoproliferative glomerulonephritis (MPGN) represents a significant clinical challenge, signifying a substantial risk of allograft dysfunction and loss. We aimed to present a case of MPGN in a kidney transplant recipient with its diagnostic and therapeutic challenge. We repo

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The Arab Journal of Nephrology and Transplantation is the peer-reviewed open-access journal of ASNRT, published since 2008.

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