Recurrent atypical antiglomerular basement membrane nephritis in the kidney transplant

Salvatore E. Mignano, Samih H. Nasr, Mary E. Fidler, Loren P. Herrera Hernandez, Mariam P. Alexander, Sanjeev Sethi, Nidia Messias, Tarek Alhamad, Louai Alrata, Sam T. Albadri, Lynn D. Cornell

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1 Scopus citations


Atypical antiglomerular basement membrane (anti-GBM) nephritis can be defined as linear GBM staining for monotypic or polytypic immunoglobulin (Ig) by immunofluorescence (IF) without a diffuse crescentic pattern. We describe the clinicopathologic features of 6 patients (18 biopsies) in this first series of recurrent atypical anti-GBM nephritis after kidney transplantation. Recurrent glomerulonephritis occurred at a mean of 3.8 months posttransplant (range 1-7 months). Three index biopsies were for clinical indication, and 3 were protocol biopsies. Glomerular histologic changes were mild, with 2 showing segmental endocapillary hypercellularity, 1 focal glomerular microangiopathy, and the others no significant glomerular histologic changes. All 6 allografts showed monotypic linear glomerular Ig staining by IF: IgG kappa (n = 2), IgG lambda, IgA kappa, IgA lambda, and IgM lambda. Follow-up biopsies were available for 5 patients and showed similar histologic and IF findings without evidence of significant progression. No patients had detectable serum anti-GBM antibody or monoclonal proteins. The mean serum creatinine level on follow-up (24-62 months posttransplant) was 1.8 (range 0.93-2.77) mg/dL; no grafts were lost to recurrent disease. This series demonstrates that monotypic atypical anti-GBM recurs in the allograft and supports the idea that this disease is due to a circulating monoclonal protein.

Original languageEnglish
Pages (from-to)123-133
Number of pages11
JournalAmerican Journal of Transplantation
Issue number1
StatePublished - Jan 2024


  • Glomerulonephritis
  • allograft
  • atypical anti-GBM
  • atypical antiGBM
  • biopsy
  • monoclonal
  • monotypic
  • pathology
  • recurrent disease


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