Intravenous immunoglobulins modify relapsing membranous glomerulonephritis after kidney transplantation: a case report

Abstract

Objectives: Recurrence of membranous glomerulonephritis after transplant is common and is an important cause of loss of renal graft. This case supports the effect of immunoglobulins in the treatment of this disease after transplantation. It is the first report in the literature with a follow-up of more than 10 years and because of the sustained effect of the immunoglobulins, it strengthens the idea that this can alter long-term outcome.

Methods: Single case study and search of the literature.

Results: A female transplant recipient, who had an early histologically proven relapse of an idiopathic membranous glomerulonephritis and who was, before transplantation, refractory to various immunosuppressive agents. This relapsing disease has now been stable for over 10 years of intravenous immunoglobulins treatment in conjunction with belatacept and low doses of corticosteroids after gradual withdrawal of mycophenolate mofetil. This report supports the finding that immunoglobulins could influence the course of a relapse of membranous glomerulonephritis after transplantation.

Conclusion: This case illustrates that immunoglobulins had long-lasting effects on the renal transplant although the glomerulonephritis had been resistant to other lines of therapy before transplant. We advocate that the use of immunoglobulins as a rescue therapy in refractory idiopathic membranous glomerulonephritis should be further investigated. Presently, existing evidence only comes from retrospective data and non-randomized trials.

Keywords:

• Immunoglobulins
• membranous nephropathy
• kidney transplant
• relapsing

Abbreviations:

• APLA2R, anti-phospholipase 2-receptor antibodies
• CD80, podocytic B7–1 protein
• CTLA-4, cytotoxic T-lymphocyte-associated antigen 4
• FSGS, focal segmental glomerulosclerosis
• GBMs, glomerular basement membranes
• HLA, human leukocyte antigen
• IMGN, membranous glomerulonephritis
• IVIG, intravenous gamma-globulins
• MMF, mycophenolate mofetil