Subclinical recurrence of IgA nephropathy after kidney transplantation is well recognized. Only protocol biopsies of clinically silent recipient can provide the accurate prevalence of recurrent IgA nephropathy. The study of recurrent glomerulonephritis will contribute not only to improving long-term graft survival, but also to clarifying the pathogenesis Saracatinib clinical trial of glomerulonephritis. Protocol biopsy is one the most effective methods for elucidating the pathogenesis of recurrent

glomerulonephritis. Recurrence of native kidney disease following kidney transplantation affects between 10% and 20% of patients, and accounts for up to 8% of graft failures at 10 years post transplant.[1-8] The most comprehensive data on graft loss as a result of recurrent glomerulonephritis derives from an Australian study involving 1505 patients with biopsy-proven glomerulonephritis as a primary cause of end-stage renal disease (ESRD).[6] Recurrent glomerulonephritis, including

secondary glomerulopathies, is the third most common risk factor for graft failure. Estimated rates of recurrence and graft loss risk for primary glomerulonephritis and secondary glomerulopathy reported in many studies are summarized in Table 1. The relative importance of recurrence as a cause of graft loss increases with time after transplantation.[6] Recurrent glomerulonephritis added further weight to the risk of graft failure after the introduction of potent immunosuppressive agents. Graft survival rates within 10 years of transplantation have improved Ibrutinib order tremendously due to the significant reduction in both T-lymphocyte-mediated and antibody-mediated rejection since current immunosuppressive regimens were adopted. Furthermore, adequate histological

diagnosis based on the Banff classification has greatly contributed to improved graft survival. However, the idea that strong immunosuppressive agents can reduce the recurrence of glomerulonephritis after kidney transplantation remains controversial. The preventive effect of new immunosuppressive agents is limited and many reports also suggest that the prevalence of recurrence is not decreasing. Recurrent and de novo glomerular diseases are classified according to clinical or histological criteria. Glomerulonephritis of the transplanted kidney can be caused by either recurrent or de novo disease. However, a considerable number of cases of transplant glomerulopathy are impossible to classify into recurrent or de novo type. A new concept as the third category – transplant glomerulopathy with unknown primary disease – is necessary for accurate estimation of post-transplant glomerulopathy. Wide variation exists in the reported rates of recurrence of different renal diseases and the ensuing rates of graft loss. Accurate estimation of the incidence of recurrence is difficult,[7] and depends on the type and study methods of graft biopsies.