*Purpose: Describe higher than anticipated prevalence of Mesangiopathic Glomerulonephritis on surveillance biopsies.

*Methods: Review of all surveillance biopsies from September 2014 through September 2018 for presence of Mesangiopathic Glomerulonephritis and analysis of patient characteristics, graft function, and graft survivial.

*Results: Mesangiopathic Glomerulonephritis (MeGN) is an uncommon cause of CKD and has been rarely seen in kidney transplant recipients. MeGN can be seen when deposition of immunoglobulin in the mesangium provokes the proliferation of matrix and mesangial cells. This pattern of injury can be seen in glomerular diseases such as IgA nephropathy and lupus nephropathy. We describe a case series of de-novo MeGN seen on surveillance allograft biopsies in kidney transplant recipients We reviewed surveillance biopsy data performed at our institution from September 2014 through September 2018. The biopsy was performed 6.3 ± 1.1 months post-transplant. We identified 24 of 499 patients (4.8%) with MeGN. Of those, 50% were men, 54% were African-American and 50% underwent deceased donor kidney transplant. Patients received standard Thymoglobulin (67%) or Alemtuzumab (33%) induction and were maintained on tacrolimus (96%), mycophenolate (100%), and prednisone (79%). The most common causes of ESRD were hypertension (29%) and diabetic nephropathy (25%). None of the included patients had SLE or IgA nephropathy pre-transplant. At biopsy, the mean creatinine was 1.26 ± 0.32 mg/dL (0.7-2.1 mg/dL), mean urine protein creatinine ratio of 0.2 ± 0.1 g/g (0.1-0.6) and mean tacrolimus level of 7.38 ± 1.86 ng/mL (4.4-11.9 ng/mL) . On immunofluorescence, 33% of the patients had full house mesangial staining with 3 patients with IgA dominant staining. On electron microscopy, 75% of the patients had immune complex depositions. Further workup revealed normal complements, negative ANA, negative serum free light chains, negative DSA and no chronic or active infection at the time of biopsy. Follow up of 15.3 ± 9 months yielded no significant change in kidney function with mean creatinine of 1.25 ± 0.35 mg/dL (0.7-2.3 mg/dL), and mean urine protein creatinine ratio of 0.28 ± 0.19 g/g (0.07-1.94 g/g).

*Conclusions: Our data indicate the MeGN present on surveillance biopsy without other clinical manifestations is self-limited and does not have a readily identifiable cause. No additional therapy other than conventional immunosuppression is necessary.

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