De novo fibrillary glomerulopathy in the renal allograft of a patient withsystemic lupus erythematosus

Lupus glomerulonephritis is a complication of systemic lupus erythematosus, with 10% of the patients developing end-stage renal disease. It is accepte d that lupus patients are good candidates for kidney transplantation and th at the disease activity is subdued after transplantation due to rigorous im munosuppression, with a low rate of graft loss due to recurrent glomerulone phritis, While recurrent fibrillary glomerulopathy has been reported in ren al allografts, de novo disease has not. We report a patient with systemic l upus who underwent a renal transplantation and subsequently lost her allogr aft due to de novo fibrillary glomerulopathy, Four years after her first ki dney transplant, the patient presented with acute deterioration of her rena l function. A renal biopsy was performed, and it revealed a focal mesangiop roliferative pattern with positive amorphous mesangial immunofluorescence s taining for IgG and C3, Congo red staining was negative. Electron microscop y demonstrated the presence of randomly oriented nonamyloid fibrils in the mesangiun, The diagnosis of de novo fibrillary glomerulopathy was made, The patient lost her allograft and received a second cadaveric renal transplan t 1 year later. She has had a stable renal function since then, Copyright ( C) 2001 S. Karger AG. Basel.