Early recurrence of active IgA nephropathy after kidney transplantation.
IgA nephropathy (IgAN) is recurrent after transplantation; however, its time of recurrence is unpredictable. To date, factors influencing IgAN recurrence have not been elucidated. We present a case of a 23-year-old man with end-stage renal disease (ESRD) who underwent living-related ABO-identical pre-emptive kidney transplantation (PEKT) using his 57-year-old mother as a donor. IgAN started when the patient was 19 years old, and renal biopsy revealed the usual pathological findings of IgAN. In spite of steroid therapy including steroid pulse and tonsillectomy, the patient developed nephrotic syndrome and progressed to ESRD in 4 years. Protocol biopsy on day 19 following PEKT revealed active recurrent IgAN. Nephrotic-range proteinuria and mild deterioration of kidney function developed regardless of strong immunosuppressive therapy such as steroid pulse, double filtration plasmapheresis and rituximab. We report a case of refractory IgAN that recurred 19 days after transplantation. This case is considered of value to elucidate factors leading to active IgAN recurrence.
Department of Nephrology and Transplantation Center, Japanese Red Cross Nagoya Daini Hospital, Nagoya, Japan.
Yasuhiro
Y
Otsuka
Asami
A
Takeda
Keiji
K
Horike
Daijyo
D
Inaguma
Norihiko
N
Goto
Yoshihiko
Y
Watarai
Kunio
K
Morozumi
D058846:Antibodies, Monoclonal, Murine-Derived / Q000627:therapeutic use; D005922:Glomerulonephritis, IGA / Q000188:drug therapy / Q000473:pathology* / Q000601:surgery*; D006801:Humans; D007155:Immunologic Factors / Q000627:therapeutic use; D007676:Kidney Failure, Chronic / Q000473:pathology / Q000601:surgery; D016030:Kidney Transplantation / Q000009:adverse effects*; D008297:Male; D010956:Plasmapheresis; D011183:Postoperative Complications / Q000188:drug therapy / Q000209:etiology* / Q000473:pathology*; D012008:Recurrence; D000069283:Rituximab; D055815:Young Adult
D058846:Antibodies, Monoclonal, Murine-Derived; D007155:Immunologic Factors; D000069283:Rituximab
IgA nephropathy; early recurrence; recurrent IgA nephropathy; recurrent glomerulonephritis; renal transplantation