MASSIVE POST-TRANSPLANT PROTEINURIA WITH MINIMAL HISTOLOGICAL CHANGES

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Abstract
Three patients developed massive proteinuria, hypoalbuminemia, and edema after transplantation. These findings occurred in the immediate post-transplant period in 2 patients and renal failure developed. The 3rd patient developed proteinuria 4 mo. post-transplantation. There was complete remission of proteinuria in 2 patients and recovery of renal function in one. Renal histology was similar in all. Light microscopy demonstrated that the glomeruli contained a mild increase in mesangial matrix, but were otherwise normal. No significant interstitial cellular infiltration or fibrosis was present. Immunofluorescence microscopy revealed no staining for immunoglobulins or complement. EM demonstrated fusion of foot processes, but the glomerular basement membrane was normal. No electron-dense deposits were found. The usual causes of post-transport nephrotic syndrome were ruled out. These 3 patients may represent a unique disorder of the transplanted kidney.