Darji PI, Patel HA, Darji BP, Sharma A, Halawa A. Is de novo membranous nephropathy suggestive of alloimmunity in renal transplantation? A case report. World J Transplant 2022; 12(1): 15-20 [PMID: 35096553 DOI: 10.5500/wjt.v12.i1.15]
Reader's ID:
05339586
Submitted on:
February 25, 2022, 01:50
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Reader Comments:
The authors presented a very interesting case of de novo membranous nephropathy in a 22-year-old male after receiving a living donor kidney transplantation from his mother. They excluded the potential causes of secondary membranous nephropathy including viral infections, antibodies mediated rejection, and malignancy. Accordingly, they hypothesized that an immunological factor could be postulated as a cause. This was dependent on the results of examination of biopsy and exclusion of the known causes of secondary pathology. This case may have a high impact on the awareness of the physicians and theirs plans of management of similar cases. However, the important critical points are:
1. There are no information about the remaining antigens of HLA such as DP and DQ antigens.
2. The primary pathology as a chronic pyelonephritis was not confirmed or excluded by biopsy. History of surgical correction of the ureteral reflux at the age of 6 is not sufficient to settle this diagnosis. May co-existence of a second primary pathology be considered in the presence of anomalous urinary tract?
3. The postulation of the exposure of podocyte cryptic antigens after a pathological injurious insults to initiate an immunological pathway for membranous nephropathy seems to not supported by a direct proof from this case.
4. The therapeutic policy of increasing the tacrolimus dose and introduction of an agent of angiotensin converting enzyme inhibitors was not clear whether it was given as a therapeutic test.
Reply from the Editorial Office:
First, thank you very much for your professional comments on the article published in World Journal of Transplantation.
Second, we read your comments with great interest. You are welcome to format your valuable comments into a Letter to the Editor and submit it online to World Journal of Transplantation at https://www.f6publishing.com. There are no restrictions on the number of words, figures (color, B/W) or authors for a Letter to the Editor. In addition, the article processing charge will be exempted for this Letter to the Editor. As with all articles published by the Baishideng Publishing Group, the Letter to the Editor will be published online after completing peer review. The guidelines for a Letter to the Editor can be found at: https://www.wjgnet.com/bpg/GerInfo/219.
Finally, we look forward to receiving your high-quality Letter to the Editor, which will promote academic communication and lead the development of this discipline.
Reader's ID:
02906184
Submitted on:
February 18, 2022, 03:33
Reader Expertise:
Reader’s expertise on the topic of the manuscript
Conflicts-of-Interest Statement:
Does the reader have a conflict of interest?
Reader Comment Standards for Published Articles:
1 Title
Does the title reflect the main subject/hypothesis of the manuscript?
2 Abstract
Does the abstract summarize and reflect the work described in the manuscript?
3 Key Words
Do the key words reflect the focus of the manuscript?
4 Background
Does the manuscript adequately describe the background, present status and significance of the study?
5 Methods
Does the manuscript describe methods (e.g., experiments, data analysis, surveys, and clinical trials, etc.) in adequate detail?
6 Results
Are the research objectives achieved by the experiments used in this study?
Has the study made meaningful contributions towards research progress in this field?
7 Discussion
Does the manuscript interpret the findings adequately and appropriately, highlighting the key points concisely, clearly and logically?
Are the findings and their applicability/relevance to the literature stated in a clear and definite manner?
Is the Discussion accurate and does it discuss the paper’s scientific significance and/or relevance to clinical practice sufficiently?
8 Illustrations and Tables
Are the figures, diagrams and tables sufficient, good quality and appropriately illustrative of the paper contents?
Do figures require labeling with arrows, asterisks, etc., or better legends?
9 Biostatistics
Does the manuscript meet the requirements of biostatistics?
10 Units
Does the manuscript meet the requirements of use of SI units?
11 References
Does the manuscript appropriately cite the latest, important and authoritative references in the Introduction and Discussion sections?
Does the author self-cite, omit, incorrectly cite and/or over-cite references?
12 Quality of manuscript organization and presentation
Is the manuscript concisely and coherently organized and presented?
Are the style, language and grammar accurate and appropriate?
13 Ethics statements
For all manuscripts involving human studies and/or animal experiments, author(s) must submit the related formal ethics documents that were reviewed and approved by their local ethical review committee. Did the manuscript meet the requirements of ethics?
Scientific Quality:
The overall quality of the manuscript, based on the above-listed criteria, should be evaluated and classified according to the following five categories
Language Quality:
Language quality (style, grammar, and spelling) should be evaluated and classified according to the following five categories.
Reader Comments:
This manuscript is very interesting to demonstrate a case of early post transplant nephrotic syndrome which was diagnosed as de novo membranous nephropathy. This case dramatically response to treatment with increase dose of Tacrolimus. And the authors claim that de novo membranous nephropathy in this case might be related with alloantibody. Preliminary, I agree with this conclusion.
Comments.
1. In general, a mother to son donation should have one haplotype sharing and is expected to have 1 HLA DR mismatch. However the authors described that the HLA DR mismatch is zero. It will be more informative if the authors described the method of HLA typing technique. For example, HLA DNA method is more precise to differentiate HLA DR 1501 and 1502. Both antigens might be reported as HLA DR 15 if the typing was done by serologic method. In this case, DNA technique is helpful to differentiate true zero DR mismatch from apparently zero DR mismatch . In addition, alloantibody may be from HLA A and B antigens that are presence in this donor-recipient relationship. Thus it would be a good teaching if the reader can see the description of HLA A and B antigens of both the donor and recipient.
2. Since it was observed that there are different common HLA antigens among population with different ethnic. It will be more informative if the reader can know the ethnicity of this donor and recipient pair.
Reply from the Editorial Office:
First, thank you very much for your professional comments on the article published in World Journal of Transplantation.
Second, we read your comments with great interest. You are welcome to format your valuable comments into a Letter to the Editor and submit it online to World Journal of Transplantation at https://www.f6publishing.com. There are no restrictions on the number of words, figures (color, B/W) or authors for a Letter to the Editor. In addition, the article processing charge will be exempted for this Letter to the Editor. As with all articles published by the Baishideng Publishing Group, the Letter to the Editor will be published online after completing peer review. The guidelines for a Letter to the Editor can be found at: https://www.wjgnet.com/bpg/GerInfo/219.
Finally, we look forward to receiving your high-quality Letter to the Editor, which will promote academic communication and lead the development of this discipline.