Membranous glomerulonephritis in transplant kidneys: recurrent or de novo disease in four patients.

Membranous glomerulonephritis in the graft is a uncommon complication of renal transplantation. In the 4 cases we describe, one patient had recurrence of his original disease, but in the other 3 it arose de novo after allografting for focal segmental glomerulosclerosis, cystinuria or secondary amyloidosis. The lesion was accompanied by mesangial changes of lesser degree and by chronic rejection, and it resulted in accelerated loss of graft function. Transmission of host disease to the graft is more likely to occur in patients whose original membranous lesion progressed to renal failure relatively rapidly, while in de novo cases, the antecedent host disease seems often to have been focal segmental glomerulosclerosis. Allograft membranous glomerulonephritis may be less rare than hitherto supposed.