Kidney biopsy teaching case
A 65-year-old man with early renal allograft dysfunction

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Clinical history

In 1991 a 55-year-old man presented with nephrotic syndrome. Urinary protein was 15.6 g/24 h. Serum creatinine was 2.6 mg/dL (230 μmol/L).

First renal biopsy

Light microscopy showed an MPGN with moderate mesangial hypercellularity and prominent glomerular peripheral capillary wall double contours (Fig 1A). Immunofluorescence (IF) demonstrated peripheral capillary wall and mesangial granular staining for C3. Staining for immunoglobulin G (IgG), IgA, IgM, C1q, and κ and λ light chains was negative. Electron

Discussion

This patient showed the diagnostic features of DDD in his original renal biopsy with a membranoproliferative pattern on light microscopy, peripheral capillary wall staining for C3 on IF, and extremely electron-dense ribbon-like deposits within GBM on EM. Similar IF and EM appearances were seen within the renal allograft biopsy 5 weeks after transplantation. The unusual features in this man were (1) the presentation of DDD at the age of 55 years, as this disease usually has its onset in

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Cited by (2)

  • Initial Response to Immunosuppressive and Renoprotective Treatment in Posttransplant Glomerulonephritis

    2006, Transplantation Proceedings
    Citation Excerpt :

    There are not consistent data about treatment of posttransplant membranoproliferative GN. It has been reported that treatment of type II with plasmapheresis and cyclophosphamide in the case of crescents or rapid loss of renal function, lead to a partial response.29 In the present study, the best results (reduction of SCr and proteinuria) were observed in patients with recurrent membranous PTxGN using the scheme of Ponticelli (IV and PO corticosteroid (CS) plus PO cyclophosphamide (CPP); such a response was also seen in patients with recurrent or de novo FSGS that used PO CS or CPP, except when initial SCr > 2.5 mg/dL.

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