Evaluating the clinical course and prognostic factors of posttransplantation immunoglobulin A nephropathy.
BACKGROUND
Previous reports have suggested that posttransplantation immunoglobulin (Ig) A nephropathy displays a relatively benign course, hardly ever affecting graft function. However, more recent studies with longer follow-up have shown that posttransplantation IgA nephropathy may be a significant contributor to graft loss. Additionally, there may be other clinical or pathological factors that affect long-term graft outcome. We retrospectively analyzed 30 kidney transplant recipients with biopsy-proven IgA nephropathy in their allografts to determine the clinical course and prognostic factors in posttransplantation IgA nephropathy. The median duration of follow-up was 36 months (range, 1 month-17 years). The median onset of IgA nephropathy was 33.6 months posttransplantation (range, 5 days-103 months). The most common presentation was an abnormal urine examination (96.6%). Fifteen (50%) displayed microscopic hematuria with proteinuria more than 1 g/d. Fifteen patients (50%) lost their grafts at a median time of 24 months after the onset of disease (range, 1-93 months). Allograft loss was associated with a high serum creatinine level at the time of diagnosis (3.68 +/- 2.23 vs 1.79 +/- 0.34 mg/dL; P = .006), a greater level of proteinuria at the time of diagnosis (2.43 +/- 0.76 vs 1.29 +/- 1.07 g/d; P = .003), and more than 50% extracapillary proliferation (P = .05). Fibrinoid necrosis on allograft pathology impacted 1-year allograft survival (P = .025).


CONCLUSIONS
Posttransplantation IgA nephropathy worsens allograft outcomes among patients with increased serum creatinine level or significant proteinuria at presentation or significant glomerular inflammation and/or tubulointerstitial damage.
Kiattisunthorn
K
K
Renal Unit, Siriraj Hospital, Mahidol University, Bangkok, Thailand. tekkt@mahidol.ac.th
Premasathian
N
N
Wongwiwatana
A
A
Parichatikanond
P
P
Cheunsuchon
B
B
Vasuvattakul
S
S
D000328:Adult; D001794:Blood Pressure; D002102:Cadaver; D003404:Creatinine / Q000097:blood; D005260:Female; D005500:Follow-Up Studies; D005922:Glomerulonephritis, IGA / Q000209:etiology* / Q000503:physiopathology*; D006680:HLA Antigens / Q000276:immunology; D006650:Histocompatibility Testing; D006801:Humans; D016030:Kidney Transplantation / Q000009:adverse effects* / Q000276:immunology; D019520:Living Donors; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D011507:Proteinuria / Q000209:etiology; D012189:Retrospective Studies; D013997:Time Factors; D014019:Tissue Donors
D006680:HLA Antigens; D003404:Creatinine