[A clinicopathological study of recurrent IgA nephropathy following renal transplantation].
The present study was conducted to examine the clinicopathological features of recurrent IgA nephropathy (IgAN) following renal transplantation. Serial renal biopsies were performed regularly at 0-hour, 1-hour and 2-hours, and 39 episode biopsies were carried out when patients had increased serum creatinine levels and proteinuria. In 49 renal allograft recipients with IgAN, 12 patients were proved to be recurrent IgAN (24.5%). There was a significantly increased five- and ten-year risk of graft loss in the renal allograft recipients with biopsy-proved recurrent IgAN. Graft survival in 49 renal allograft recipients with IgAN was worse (68.8% at 5 years and 40.4% at 10 years) than that in 997 whole transplants (80.7% at 5 years, and 67.7% at 10 years). We found significant differences in the prevalence of HLA-DR4 (66.7%) and BW35 (25%) in the renal allograft recipients with recurrent IgAN when compared with normal healthy subjects. The renal allograft recipients with recurrent IgAN had a high incidence of proteinuria (8/12), hypertension (9/12) and renal dysfunction of less than 50 ml/min (7/12). Mean hemodialysis duration before renal transplantation in recurrent IgAN transplants was 12.5 months, which was shorter than in those without recurrent IgAN. Histopathological studies revealed that renal lesions due to IgAN frequently appeared in the renal allograft recipients with recurrent IgAN. Taken together, these findings suggest that donor-recipient matching may be carefully reconsidered, and recurrent IgAN after renal transplantation must be treated with effective immunosuppressive therapy.
Matsugami
K
K
Department of Medicine, Tokyo Women's Medical College.
Naito
T
T
Nitta
K
K
Nihei
H
H
Tanabe
K
K
Toma
H
H
Yamaguchi
Y
Y
D000328:Adult; D005260:Female; D005922:Glomerulonephritis, IGA / Q000401:mortality / Q000473:pathology*; D006801:Humans; D006977:Hypertension, Renal / Q000150:complications; D016030:Kidney Transplantation / Q000401:mortality; D008297:Male; D011183:Postoperative Complications; D011379:Prognosis; D011507:Proteinuria / Q000473:pathology; D012008:Recurrence; D015996:Survival Rate