De novo lupus-like glomerulonephritis after pediatric non-kidney organ transplantation.
Glomerulonephritis
Intestinal transplant
Liver transplant
Pediatric
Journal
Pediatric nephrology (Berlin, Germany)
ISSN: 1432-198X
Titre abrégé: Pediatr Nephrol
Pays: Germany
ID NLM: 8708728
Informations de publication
Date de publication:
01 2022
01 2022
Historique:
received:
30
03
2021
accepted:
15
06
2021
revised:
08
06
2021
pubmed:
23
7
2021
medline:
30
3
2022
entrez:
22
7
2021
Statut:
ppublish
Résumé
We propose a novel clinically significant finding, de novo lupus-like glomerulonephritis (DNLLGN), in patients with autoantibodies and kidney abnormalities in pediatric liver transplant (LT) and intestinal inclusive transplants (ITx). We describe the clinical, serologic, and histopathologic presentation and kidney outcomes in eight patients from our center found to have DNLLGN on kidney biopsy. Pediatric recipients of non-kidney solid organ transplants developed an unusual de novo immune complex glomerulonephritis with morphologic similarity to lupus nephritis. Six had isolated LT (0.9% of all pediatric LT at our center) and two had ITx (2.1% of all ITx). Five (63%) presented with nephrotic syndrome. Five patients had autoantibodies. Patients underwent kidney biopsy at a mean of 11.5 years in LT and 2.8 years in ITx after the index transplant. Biopsies demonstrated changes similar to focal or diffuse active lupus. Follow-up eGFR at a mean of 6 years after biopsy showed a mean decrease of 30 ml/min/1.73 m DNLLGN has not been previously recognized in this clinical setting, yet 8 kidney biopsies from pediatric recipients of LT and ITx at our center in 25 years demonstrated this finding. DNLLGN appears to be an under-reported phenomenon of clinical significance. A higher resolution version of the Graphical abstract is available as Supplementary information.
Sections du résumé
BACKGROUND
We propose a novel clinically significant finding, de novo lupus-like glomerulonephritis (DNLLGN), in patients with autoantibodies and kidney abnormalities in pediatric liver transplant (LT) and intestinal inclusive transplants (ITx).
METHODS
We describe the clinical, serologic, and histopathologic presentation and kidney outcomes in eight patients from our center found to have DNLLGN on kidney biopsy.
RESULTS
Pediatric recipients of non-kidney solid organ transplants developed an unusual de novo immune complex glomerulonephritis with morphologic similarity to lupus nephritis. Six had isolated LT (0.9% of all pediatric LT at our center) and two had ITx (2.1% of all ITx). Five (63%) presented with nephrotic syndrome. Five patients had autoantibodies. Patients underwent kidney biopsy at a mean of 11.5 years in LT and 2.8 years in ITx after the index transplant. Biopsies demonstrated changes similar to focal or diffuse active lupus. Follow-up eGFR at a mean of 6 years after biopsy showed a mean decrease of 30 ml/min/1.73 m
CONCLUSIONS
DNLLGN has not been previously recognized in this clinical setting, yet 8 kidney biopsies from pediatric recipients of LT and ITx at our center in 25 years demonstrated this finding. DNLLGN appears to be an under-reported phenomenon of clinical significance. A higher resolution version of the Graphical abstract is available as Supplementary information.
Identifiants
pubmed: 34292379
doi: 10.1007/s00467-021-05194-6
pii: 10.1007/s00467-021-05194-6
pmc: PMC8674157
doi:
Substances chimiques
Autoantibodies
0
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
153-161Informations de copyright
© 2021. This is a U.S. government work and not under copyright protection in the U.S.; foreign copyright protection may apply.
Références
Ojo A, Held PJ, Friedrich PK, Wolfe RA, Leichtman AB, Young EW, Arndorfer J, Christensen L, Merion RM (2003) Chronic renal failure after transplantation of a nonrenal organ. N Engl J Med 349:931–940
doi: 10.1056/NEJMoa021744
Schwarz A, Haller H, Schmitt R, Schiffer M et al (2010) Biopsy-diagnosed renal disease in patients after transplantation of other organs and tissues. Am J Transplant 10:2017–2025. https://doi.org/10.1111/j.1600-6143.2010.03224.x
doi: 10.1111/j.1600-6143.2010.03224.x
pubmed: 20883535
Hingorani S (2008) Chronic kidney disease after liver, cardiac, lung, heart-lung, and hematopoietic stem cell transplant. Pediatr Nephrol 2:879–888. https://doi.org/10.1007/s00467-008-0785-2
doi: 10.1007/s00467-008-0785-2
Suzuki M, Mujtaba MA, Sharfuddin AA, Yaqub MS, Mishler DP, Faiz S, Vianna RM, Mangus RS, Tector JA, Taber TE (2012) Risk factors for native kidney dysfunction in patients with abdominal multivisceral/small bowel transplantation. Clin Transpl 26:E351–E358. https://doi.org/10.1111/j.1399-0012.2012.01672.x
doi: 10.1111/j.1399-0012.2012.01672.x
Terzi A, Özdemir BH, Taşlıca FZ, Özdemir FN, Kırnap M, Habera M (2014) Clinicopathologic study of kidney biopsies in patients before or after liver transplant. Exp Clin Transplant 12:129–135
pubmed: 24635810
Sise ME, Wisocky J, Rosales IA, Chute D, Holmes JA, Corapi KM, Babitt JL, Tangren JS, Hashemi N, Lundquist AL, Williams WW, Mount DB, Andersson KL, Rennke HG, Smith RN, Colvin R, Thadhani RI, Chung RT (2016) Lupus-like immune complex mediated glomerulonephritis in patients with hepatitis C virus infection treated with oral, interferon-free, direct-acting antiviral therapy. Kidney Int Rep 1:135–143. https://doi.org/10.1016/j.ekir.2016.06.006
doi: 10.1016/j.ekir.2016.06.006
pubmed: 27990496
pmcid: 5155703
Ozdemir BH, Ozdemir FN, Sezer S, Colak T, Haberal M (2006) De novo glomerulonephritis in renal allografts with hepatitis C virus infection. Transplant Proc 38:492–495. https://doi.org/10.1016/j.transproceed.2005.12.109
doi: 10.1016/j.transproceed.2005.12.109
pubmed: 16549157
Hariharan S, Adams MB, Brennan DC, Davis CL, First MR, Johnson CP, Ouseph R, Peddi VR, Pelz CJ, Roza AM, Vincenti F, George V (1999) Recurrent and de novo glomerular disease after renal transplantation: a report from Renal Allograft Disease Registry (RADR). Transplantation 68:635–641. https://doi.org/10.1097/00007890-199909150-00007
doi: 10.1097/00007890-199909150-00007
pubmed: 10507481
Rijnink EC, Teng YK, Kraaij T, Wolterbeek R, Bruijn JA, Bajema IM (2017) Idiopathic non-lupus full-house nephropathy is associated with poor renal outcome. Nephrol Dial Transplant 32:654–662. https://doi.org/10.1093/ndt/gfx020
doi: 10.1093/ndt/gfx020
pubmed: 28340077
Bajema IM, Wilhelmus S, Alpers CE, Bruijn JA et al (2018) Revision of the International Society of Nephrology/Renal Pathology Society classification for lupus nephritis: clarification of definitions, and modified National Institutes of Health activity and chronicity indices. Kidney Int 93:789–796. https://doi.org/10.1016/j.kint.2017.11.023
doi: 10.1016/j.kint.2017.11.023
pubmed: 29459092
Huerta A, Bomback AS, Liakopoulos V, Palanisamy A, Stokes MB, D'Agati VD, Radhakrishnan J, Markowitz GS, Appel GB (2012) Renal-limited ‘lupus-like’ nephritis. Nephrol Dial Transplant 27:2337–2342. https://doi.org/10.1093/ndt/gfr663
doi: 10.1093/ndt/gfr663
pubmed: 22207326
Wen YK, Chen ML (2010) Clinicopathological study of originally non-lupus “full-house” nephropathy. Ren Fail 32:1025–1030
doi: 10.3109/0886022X.2010.510614
Pellegrini L, Parrilli G, Santonicola A, Cinquanta L, Caputo C, Ciacci C, Zingone F (2017) Lack of clinical relevance of ANA and ASMA positivity in patients with liver transplantation without a history of autoimmune diseases. Biomed Res Int:2456916. https://doi.org/10.1155/2017/2456916
Avitzur Y, Ngan BY, Lao M, Fecteau A, Ng VL (2007) Prospective evaluation of the prevalence and clinical significance of positive autoantibodies after pediatric liver transplantation. J Pediatr Gastroenterol Nutr 45:222–227. https://doi.org/10.1097/MPG.0b013e31805ce219
doi: 10.1097/MPG.0b013e31805ce219
pubmed: 17667719
Chen CY, Ho MC, Wu JF, Jeng YM, Chen HL, Chang MH, Lee PH, Hu RH, Ni YH (2013) Development of autoantibodies after pediatric liver transplantation. Pediatr Transplant 17:144–148. https://doi.org/10.1111/petr.12032
doi: 10.1111/petr.12032
pubmed: 23217026
Stokes MB, D'Agat VD (2019) Classification of lupus nephritis; time for a change? Adv Chronic Kidney Dis 26:323–329. https://doi.org/10.1053/j.ackd.2019.06.002
doi: 10.1053/j.ackd.2019.06.002
pubmed: 31733716
Harris PA, Taylor R, Thielke R, Payne J, Gonzalez N, Conde JG (2009) Research electronic data capture (REDCap)--a metadata-driven methodology and workflow process for providing translational research informatics support. J Biomed Inform 42:377–381
doi: 10.1016/j.jbi.2008.08.010
Schwartz GJ, Muñoz A, Schneider MF, Mak RH, Kaskel F, Warady BA, Furth SL (2009) New equations to estimate GFR in children with CKD. J Am Soc Nephrol 20:629–637. https://doi.org/10.1681/ASN.2008030287
doi: 10.1681/ASN.2008030287
pubmed: 19158356
pmcid: 2653687
Levey AS, Stevens LA, Schmid CH, Zhang YL, Castro AF, Feldman HI, Kusek JW, Eggers P, Van Lente F, Greene T, Coresh J, CKD-EPI (Chronic Kidney Disease Epidemiology Collaboration) (2009) A new equation to estimate glomerular filtration rate. Ann Intern Med 150:604–612. https://doi.org/10.7326/0003-4819-150-9-200905050-00006
doi: 10.7326/0003-4819-150-9-200905050-00006
pubmed: 19414839
pmcid: 2763564
Wozniak LJ, Hickey MJ, Chan AP, Venick RS, Farmer DG, Busuttil RW, Reed EF, McDiarmid SV (2020) Angiotensin II type-1 receptor antibodies are associated with active allograft dysfunction following pediatric liver transplantation. Transplantation 104:2547–2556. https://doi.org/10.1097/TP.0000000000003206
doi: 10.1097/TP.0000000000003206
pubmed: 32101982
Feng S, Bucuvalas JC, Demetris AJ, Burrell BE, Spain KM, Kanaparthi S, Magee JC, Ikle D, Lesniak A, Lozano JJ, Alonso EM, Bray RA, Bridges NE, Doo E, Gebel HM, Gupta NA, Himes RW, Jackson AM, Lobritto SJ, Mazariegos GV, Ng VL, Rand EB, Sherker AH, Sundaram S, Turmelle YP, Sanchez-Fueyo A (2018) Evidence of chronic allograft injury in liver biopsies from long-term pediatric recipients of liver transplants. Gastroenterology. 155:1838-1851.e7. https://doi.org/10.1053/j.gastro.2018.08.023
Venick RS, Farmer DG, Soto JR, Vargas J, Yersiz H, Kaldas FM, Agopian VG, Hiatt JR, McDiarmid SV, Busuttil RW (2018) One thousand pediatric liver transplants during thirty years: lessons learned. J Am Coll Surg 226:355–366. https://doi.org/10.1016/j.jamcollsurg.2017.12.042
doi: 10.1016/j.jamcollsurg.2017.12.042
pubmed: 29410290
Zhang Q, Reed EF (2016) The importance of non-HLA antibodies in transplantation. Nat Rev Nephrol 12:484–495
doi: 10.1038/nrneph.2016.88
Lacaille F, Moes N, Hugot JP, Cezard JP, Goulet O, Ruemmele FM (2006) Severe dysimmune cytopenia in children treated with tacrolimus after organ transplantation. Am J Transplant 6:1072–1076. https://doi.org/10.1111/j.1600-6143.2006.01304.x
doi: 10.1111/j.1600-6143.2006.01304.x
pubmed: 16611346
Illescas-Montes R, Corona-Castro CC, Melguizo-Rodríguez L, Ruiz C, Costela-Ruiz VJ (2019) Infectious processes and systemic lupus erythematosus. Immunology 158:153–160. https://doi.org/10.1111/imm.13103
doi: 10.1111/imm.13103
pubmed: 31386190
pmcid: 6797874
Ruebner RL, Reese PP, Denburg MR, Abt PL, Furth SL (2013) End-stage kidney disease after pediatric nonrenal solid organ transplantation. Pediatrics 132:e1319–e1326. https://doi.org/10.1542/peds.2013-0904
doi: 10.1542/peds.2013-0904
pubmed: 24127468
pmcid: 3813394