Rosa Marlene Viero

By Rosa M. Viero and Luis Gustavo Modelli de Andrade

Recent developments in immunosuppressive therapy have reduced the loss of allografts from acute rejection, with a significant improvement in the one-year allograft survival. However, the introduction of more potent and selective new drug, had no effect on the development of chronic allograft dysfunction and the long-term outcome remains unchanged. Several and repeated different types of allograft insults such as delayed graft function, rejection episodes, drug nephrotoxicity, hypertension, dislipidemia determines a progressive damage with graft failure within a decade. There is no established maintenance immunosuppressive therapy that decreases chronic allograft dysfunction. The renin-angiotensin system is an important mediator in the pathogenesis of chronic progressive kidney diseases. Although the pathogenesis of chronic allograft nephropathy (CAN) is poorly understood, a reduced nephron function with hemodynamic changes associated with a cascade of inflammatory mediators, result in a chronic inflammatory process, progressive fibrosis and tissue remodeling. Recent evidence has shown beneficial effects of renin-angiotensin system blockade in the posttransplant with a decrease of blood pressure, proteinuria and inflammatory process.

Part of the book: Renin-Angiotensin System

By Rosa M. Viero, Bruno M. Miamoto, Vanessa dos S. Silva and Daniela C. dos Santos

Membranous nephropathy (MN) is a very common disease of male adults with nephrotic syndrome. The disease can be primary, when the cause is not known, or secondary associated with infections, drugs, neoplasias and autoimmune systemic diseases, such as systemic lupus erythematosus (SLE). The primary form accounts for 70–80% of the cases. SLE is a common cause of secondary MN affecting young women. The differential diagnosis from primary and lupus MN by clinical and morphological findings can be difficult. The search for autoantibodies against podocyte antigen M-type phospholipase A2 receptor (PLA2R) has demonstrated high positivity in the serum and renal biopsies in the primary MN and negativity in lupus MN (WHO class V). There is a large literature on the role of anti-PLA2R antibody in the diagnosis and follow-up of patients with membranous nephropathy. The aim of this review is to summarize the literature data on the etiopathogenesis of MN and the value of anti-PLA2R antibody screening for the diagnosis and management of patients.

Part of the book: Advances in Nephropathy