Research Viewpoints Recurrent Glomerulonephritis: Role of Electron Microscopy in Diagnosis

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Seshan SV, Salvatore SP: Recurrent Glomerular Diseases in Renal Transplantation with Focus on Role of Electron Microscopy. Glomerular Diseases DOI 10.1159/000517259

A recurrence of the original disease that affected the native kidney in the allografts (or isografts) of patients undergoing kidney transplantation is a common problem that has a significant impact on both short- and long-term graft survival. Recognition of these disease recurrences, especially glomerulonephritis, requires biopsy of the transplanted kidney and meticulous study of the tissue by light, immunofluorescence, and electron microscopy (EM). The added value of EM for identification of the pathogenic processes involved in recurrent glomerulonephritis has been elegantly analyzed by Dr. Surya Seshan, an experienced and knowledgeable nephron-pathologist. EM has particular utility in defining a recurrence of primary (permeability factor-related) FSGS, immune complex-mediated MPGN, C3 glomerulonephritis/dense deposit disease, fibrillary glomerulonephritis, monoclonal deposition diseases (such as amyloidosis), and diabetic nephropathy. EM is of somewhat less utility in defining recurrences of thrombotic microangiopathy, membranous nephropathy, IgA nephropathy, lupus nephritis, anti-GBM disease, ANCA vasculitis, and proliferative glomerulonephritis with mononclonal Ig deposition.

Nevertheless, this well-written and illustrated compendium of EM findings in post-transplant recurrent disease is an excellent resource and provides a broad overview of the morphological features of recurrent disease. It is worth reading and viewing in its original form.