Figure 1729

Recurrence of membranous nephropathy in transplantations is variable, with studies reporting incidences from 3% to 57% [4,37]. The major differential diagnosis is de novo membranous nephropathy in patients with a different underlying renal pathology. De novo allograft membranous glomerulonephritis reported in 2% to 5% of transplantations is often asymptomatic and usually associated with chronic rejection

[38]. In contrast, recurrent disease frequently causes nephrotic syndrome, developing within the first 2 years after transplantation. Data on the incidence of graft failure attributable to membranous disease are confusing. Cyclosporine therapy has made no difference in the incidence of the two entities, and hepatitis C virus infection may be associated with membranous disease after transplantation.

FIGURE 17-31 (see Color Plate)

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