Insidious transmission of membranous nephropathy from kidney donor with no clinical manifestations before and after transplantation

Live kidney donors are supposed to have no clinical kidney disease. Here, we present a unique case of subclinical membranous nephropathy (MN) from a living donor, who had urinalysis-free stable kidney function pre- and post-transplant. A 39-yr-old Asian woman received a second kidney graft from her spouse whose urinalysis and blood chemistry were stable and normal. Her intraoperative one-h core biopsy revealed thick glomerular basement membrane (GBM) and a bubbly type appearance, compatible with stage II MN on Churg's classification. According to two other protocol biopsies, GBM thickening persisted until month six post-transplant. Interestingly, both the donor and the recipient had stable kidney function without overt proteinuria at each monthly visit until one yr post-transplant. Taken together, we speculate that "silent" MN may exist in certain healthy individuals, who present only with histopathologically compatible MN and no other findings.