Recurrent Glomerular Disease after Kidney Transplantation: Diagnostic and Management Dilemmas
This review examines the diagnostic and management dilemmas of recurrent glomerular disease after kidney transplantation, an important and often under-recognized cause of allograft failure, and highlights emerging targeted therapies for several disease entities.
Background
Recurrence of the original glomerular disease after kidney transplant remains an important cause of allograft failure, ranking among the leading causes of late graft loss. Many post-transplant glomerular entities still suffer from incomplete understanding of their pathophysiology, which has limited the development of targeted and effective therapies.
Key recommendations
The review focuses on specific clinical dilemmas in managing recurrent focal segmental glomerulosclerosis, membranous nephropathy, atypical hemolytic uremic syndrome, C3 glomerulopathy, AL amyloidosis, and IgA nephropathy. Accurate diagnosis relies on a comprehensive allograft biopsy assessed by light microscopy, immunofluorescence, and electron microscopy, supported by disease-specific biomarkers such as anti-PLA2R antibodies for membranous nephropathy and complement evaluation for C3 glomerulopathy.
Clinical implications
Treatment is moving away from broad immunosuppression toward targeted approaches, with emerging roles for agents such as rituximab in antibody-mediated disease and complement inhibitors in complement-driven glomerulopathies. Because individual recurrent glomerular diseases are relatively rare, the review emphasizes the value of pre-transplant characterization, structured post-transplant surveillance, and multicenter collaboration to refine prevention and treatment strategies.
Category
Transplant
Source
CJASN
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