My wife is 43 years old and was diagnosed with primary Sjögren's syndrome 9 years ago. Clinically, she has only had dry eyes, dry mouth, and a positive antinuclear antibody test in these 9 years. Two months ago, she developed proteinuria and her serum creatinine increased to 1.8 mg/dL. A renal biopsy showed a membranoproliferative glomerulonephritis (MPGN) that has damaged about 50% of the glomerulus. She is on corticosteroids, cyclophosphamide, and antihypertensive therapy. She may eventually progress to end-stage renal disease (ESRD).
I have several questions:
Would she benefit from renal transplantation?
Would she have a good chance of a healthy or semi-healthy life afterward?
Is there anything that can be done now, so that she will qualify as a good transplant candidate?
Are there things that should be avoided now, so that she will qualify as a good transplant candidate?
At the present time, with a serum creatinine of 1.8 mg/dL, your wife does not have ESRD and does not need a transplant. She may respond to medical therapy for her MPGN; her nephrologist would have a better idea of the likelihood of that happening. If she were to progress and develop ESRD, then transplantation might be a suitable option. MPGN can recur in the transplanted kidney, with an incidence of 20% to 30% in type I and over 80% in type II, and can lead to graft loss in 30% to 40% of recurrences in type I and over 50% of recurrences in type II. She should, in any event, try to keep herself in the best possible medical shape, apart from these medical problems, to maximize her chances of undergoing successful renal transplantation, should that become necessary.