Figure 1733

Linear immunoglobulin G (IgG) is found in 1% to 4% of routine renal allograft biopsies from patients with neither anti-glomerular basement membrane (GBM) disease nor Alport's syndrome. Linear antibody deposition in anti-GBM disease is diffuse and global and, in practice, is rarely confused with the nonspecific antibody deposition seen in other conditions. In chronic transplantation glomerulopathy the antibody deposition is focal and segmental, and focal necrosis and cellular crescents are extremely rare. The finding of linear antibody deposits on a transplantation biopsy should lead to testing for circulating anti-GBM antibodies. Early graft loss or dysfunction, along with linear IgG staining, may be the first indication that a patient with an unidentified cause for end-stage renal disease has Alport's syndrome.

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