Nearly any primary glomerulopathy has the possibility of recurring following a kidney transplant; however, the frequency and severity with which this occurs varies to a large degree. For instance, evidence of mesangial IgA deposition can be seen in the majority of kidney transplant patients with a prior diagnosis of IgA Nephropathy; however, this does not typically lead to rapid allograft loss and therefore is not so clinically significant. Recurrent primary FSGS, on the other hand, may occur commonly and with a severity that may indeed lead to graft loss. The following is a partial list of some diseases with a high rate of recurrence following kidney transplant and their relative rates of frequency, taken in part from a short review in a 2007 Transplant Proceedings issue:1. Primary FSGS: about 40% of cases will recur, many of which ultimately lead to allograft failure. Plasma exchange and aggressive immunosuppression may be of value.
2. Primary membranous nephropathy: about 30% recurrence rate, though its severity is less than that of primary FSGS typically. Also, de novo membranous nephropathy occurs in 1-2% of all transplants.
3. MPGN: type II MPGN has a recurrence rate of about 90%, whereas type I MPGN has a recurrence rate of only about 25%.
4. HUS: the D+ type of HUS typically does not recur post-transplant; however, the congenital forms of HUS (e.g. mutations in factor H, grouped amongst the D-type of HUS) recurs frequently.
5. IgA Nephropathy/Henoch-Schonlein Purpura: recurs about 50% of the time but seldom causes allograft dysfunction.
6. primary hyperoxaluria: this disease occurs essentially 100% of the time unless it is performed as a dual liver-kidney transplant.
7. diabetic nephropathy: like IgA Nephropathy, pathologic hallmarks of diabetic nephropathy are commonly observed post-trasnsplant, but this damage typically takes years, if not decades, to become clinically significant.
There are probably others, but these are some of the major ones to remember.
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