Table 1.

Differential diagnosis of recurrent glomerulonephritisa

Diagnosis Frequency and Timing Posttransplantation Clinical Features Laboratory Features Biopsy Features
PTLD, posttransplantation lymphoproliferative disorder; HUS, hemolytic uremic syndrome; EBV, Epstein-Barr virus.
Recurrent glomerulonephritis Common; variable timing—days to years Hematuria, proteinuria, renal impairment Similar to primary glomerulonephritis Same as primary glomerulonephritis (4,5)
De novo glomerulonephritis Uncommon; variable timing but typically later than recurrence Hematuria, proteinuria, renal impairment Hepatitis B or C status, hemolysis and thrombocytopenia in HUS Type specific (4,5,8)
Graft pyelonephritis Common; may occur early or late Fever, renal impairment pyuria Positive blood or urine cultures Neutrophil infiltration
Calcineurin toxicity Very common; acute or chronic Hypertension, renal impairment, inactive urine, sediment Calcineurin exposure Tubulointerstitial fibrosis, arteriolar medial hypertrophy (16)
Acute rejection Common; early Renal impairment, oliguria Nonspecific Tubulitis ± vasculitis (16)
Chronic rejection Very common; late Renal impairment, proteinuria, hypertension Nonspecific Glomerular proliferation, membrane reduplication, vascular sclerosis, fibrosis (16)
Renal tumor/PTLD Uncommon; rare; early or late Renal impairment, renal mass Anemia, EBV positive Neoplasia—atypical cells, mitoses, lymphocytes if PTLD