Recurrent Membranous Nephropathy Management after Kidney Transplant: A Case Report

Membranous nephropathy (MN) is a podocytopathy characterized histologically by uniform thickening of the glomerular basement membrane due to the presence of subepithelial immune deposits. This disease can occur in a transplanted kidney as a recurrence of primary (Recurrent Membranous Nephropathy, RMN) or de novo disease.

Case report: 

A 40-year-old non-smoker man with a history of membranous nephropathy and resultant kidney failure, underwent a kidney biopsy 9 months after transplantation because of proteinuria of 4000 mg/day. Diagnosis of recurrence of membranous nephropathy in the transplanted kidney was made. The patient was given two doses of rituximab 1000 mg at a 15 day interval. Gradually, the amount of proteinuria decreased to 188 mg/day after 4 months, and his kidney function remained stable (creatinine 0.8 mg/dl) during the treatment.

 Membranous nephropathy can recur after kidney transplantation, and in cases of proteinuria more than one gram per day, we can use rituximab.