FIBRILLARY GLOMERULONEPHRITIS AND PULMONARY HEMORRHAGE IN A PATIENT WITH RENAL-TRANSPLANTATION

Fibrillary glomerulonephritis is an unusual kidney disease characteriz ed by the deposition of immunoglobulins in a fibrillar pattern, Until recently it has been considered to involve the kidneys alone. We descr ibe a patient who underwent renal transplantation and developed fibril lary glomerulonephritis with rapidly progressive renal failure and sev ere pulmonary hemorrhage two years and a half after transplantation. N ephropathy prior to transplantation was thought to be focal and segmen tal glomerulosclerosis. Diagnosis of fibrillary glomerulonephritis in renal allograft was confirmed by postmortem examination. 50% of the gl omeruli with extracapillary crescents were observed on light microscop y. By immunofluorescence main deposition of Iga was detected in the gl omerular capillar walls and the mesangium. Electron microscopy showed fibrillo-reticular deposits in the same place. Lung histology showed b oth old and recent areas of alveolar hemorrhage. Granular staining for IgA was observed in the alveolar walls by immunofluorescence. Ultrast ructural analysis of the lung made evident fibrillo-reticulary deposit s in the interstitium, similar than those observed in the glomeruli. T he presence of these deposits in both renal and pulmonary tissues indi cates the possibility of systemic involvement in fibrillary glomerulon ephritis. In our case it could be related to the recurrence of this gl omerulopathy in renal allograft.