Recurrent and de novo glomerulonephritis postrenal transplantation.

Important conceptual advances in recent years have been made in the area of posttransplant GN mainly in the de novo form rather than in recurrent posttransplant glomerulonephritis. Important patient subgroups have been identified for whom a significant risk exists. In particular, those carriers of hepatitis C virus may develop immune-complex renal disease leading to both MGN and MPGN. A de novo form of FSGN may occur in very long-term renal allograft patients. A case cited of an identical twin donor and her recipient developing glomerulosclerosis more than 10 years posttransplant represents an instance where the provocative hyperfiltration hypothesis was not relevant. The possibility that FK 506 may rescue cases of de novo posttransplant HUS11 is exciting and needs further elucidation. Finally, the serious lesions of CyA vasculopathy and those of chronic renal allograft rejection may be ameliorated as experience is gained with newer potent immunosuppressive drugs, such as FK 506 as the UNOS data suggest.