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Significant glomerular changes occur in a substantial number of renal cadaver allotransplants. Transplant glomerulopathy and recurrent glomerulonephritis account for most of the lesions whereas the development of de novo glomerulonephritis is a rare event. Only a few cases of membranous glomerulonephritis in the graft have been documented. The four patients presented all developed heavy proteinuria of 11.5 to 14 g/day 5 months to 1 year after transplantation. Three cases of de novo membranous glomerulonephritis were transplanted because of renal failure due to chronic pyelonephritis, chronic glomerulonephritis and medullary sponge kidney. One patient has recurrent membranous glomerulonephritis. Transplant biopsy revealed only minimal glomerular changes by light microscopy in all cases. Immunofluorescence and electron microscopy demonstrated typical membranous glomerulonephritis.
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