Kidney Week 2025 Early Program - Care of Kidney Transplant Candidates and Recipients-Recurrent Disease and Monoclonal Gammopathies After Kidney Transplantation

Video Transcription

Video Summary

Dr. Murakami reviews late recurrent kidney diseases after transplantation and how to monitor monoclonal gammopathy–related conditions. She summarizes recurrence risk, timing, and graft impact across glomerulonephritides, emphasizing that diabetic nephropathy commonly recurs 5–10 years post-transplant without tight glycemic control. For IgA nephropathy, recurrence varies widely by definition, with ~23–27% incidence by 10–15 years; steroid maintenance may reduce risk, and treatment is largely supportive, with cyclophosphamide for rapidly progressive cases. For membranous nephropathy, pre-transplant anti-PLA2R antibody testing is crucial because positivity predicts clinically significant recurrence; monitoring includes frequent proteinuria and antibody checks, and rituximab is used though dosing varies. Lupus nephritis often recurs histologically but rarely clinically; quiescence before transplant is key. ANCA and anti-GBM disease require clinical quiescence and negative/low titers. She then discusses plasma cell dyscrasias (myeloma, AL amyloidosis, MGRS/PGNMID), highlighting variable recurrence timing, emerging transplant eligibility criteria based on risk and response, and the importance of post-transplant surveillance (including SPEP and free light chains).

Asset Subtitle

Naoka Murakami

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Speaker Naoka Murakami

Keywords

kidney transplant disease recurrence

IgA nephropathy recurrence monitoring

membranous nephropathy anti-PLA2R rituximab

diabetic nephropathy post-transplant glycemic control

monoclonal gammopathy MGRS surveillance SPEP free light chains