Transplant glomerulopathy
Transplant Glomerulopathy[edit | edit source]
Transplant glomerulopathy is a chronic kidney disease that occurs in the setting of kidney transplantation. It is characterized by specific changes in the glomeruli, the filtering units of the kidney, and is a significant cause of chronic allograft dysfunction.
Pathophysiology[edit | edit source]
Transplant glomerulopathy is primarily associated with chronic antibody-mediated rejection (AMR). The condition is marked by the presence of double contours of the glomerular basement membrane, which are visible under a microscope. These changes are thought to result from endothelial injury caused by donor-specific antibodies (DSAs) targeting the transplanted kidney.
Clinical Presentation[edit | edit source]
Patients with transplant glomerulopathy often present with proteinuria, hypertension, and a gradual decline in renal function. The condition is usually detected during routine follow-up of kidney transplant recipients, often through a kidney biopsy.
Diagnosis[edit | edit source]
The diagnosis of transplant glomerulopathy is confirmed by histopathological examination of a kidney biopsy. The key histological feature is the presence of double contours of the glomerular basement membrane, which can be identified using special stains such as silver stain or periodic acid-Schiff stain.
Treatment[edit | edit source]
Management of transplant glomerulopathy involves addressing the underlying cause, which is often chronic antibody-mediated rejection. Treatment strategies may include the use of immunosuppressive therapy to reduce the activity of DSAs. In some cases, plasmapheresis or intravenous immunoglobulin (IVIG) may be used to lower antibody levels.
Prognosis[edit | edit source]
The prognosis of transplant glomerulopathy varies depending on the severity of the condition and the response to treatment. It is a progressive disease that can lead to graft loss if not adequately managed. Early detection and intervention are crucial to improving outcomes.
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Contributors: Prab R. Tumpati, MD
