Does angiotensin blockade influence graft outcome in renal transplant recipients with IgA nephropathy?

Courtney, Aisling E.; McNamee, P; Nelson, William E.; Maxwell, Alexander P.

doi:10.1093/ndt/gfl506

Cited by 47 publications

(19 citation statements)

References 18 publications

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“…Third, this study did not identify treatment strategies for high‐risk allograft IgAN, although the clinical significance of the MEST‐C score was maintained after adjustment for medications. Whether aggressive treatment using additional immunosuppressive agents or RAAS blockers could possibly improve the prognosis of allograft IgAN, particularly for recurred cases, should be investigated in future studies . Lastly, distinguishing between recurred IgAN, de novo IgAN, and donor‐driven IgAN, was not conclusive due to the lack of routinely performed protocol‐based or zero‐time biopsies and the inclusion of patients with an undiagnosed primary disease.…”

Section: Discussionmentioning

confidence: 99%

Clinical importance of the updated Oxford classification in allograft IgA nephropathy

Park

Baek

et al. 2019

American Journal of Transplantation

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With the recent update to the Oxford classification for allograft IgA nephropathy (IgAN), additional investigations on the clinical significance of the updated components are warranted. We performed a retrospective cohort study at two tertiary hospitals. Kidney transplant recipients diagnosed with allograft IgAN were included in the study after additional review by specialized pathologists. We applied the updated Oxford classification and determined the MEST-C scores of the patients. The main study outcome was death-censored graft failure within 10 years after the establishment of allograft IgAN diagnosis and was assessed using the Cox regression analysis.Three hundred thirty-three allograft IgAN patients were reviewed: 100 patients with confirmed native IgAN and 233 patients with other, clinical, or unknown primary causes for end-stage renal disease (ESRD). The updated Oxford classification for allograft IgAN demonstrated prognostic value for graft failure, and patients with multiple MEST-C components had worse outcomes. M, E, S, and C were significantly associated with the prognosis of recurred IgAN and T was the only independent prognostic parameter for allograft IgAN without confirmed native IgAN. Therefore, we suggest reporting MEST-C scores in allograft biopsies and careful interpretation of the results according to the primary cause of ESRD. K E Y W O R D Sclinical research/practice, glomerular biology and disease, graft survival, kidney (allograft) function/dysfunction, kidney disease: immune/inflammatory, kidney transplantation/ nephrology, pathology/histopathology, recurrent disease

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Section: Discussionmentioning

confidence: 99%

Clinical importance of the updated Oxford classification in allograft IgA nephropathy

Park

Baek

et al. 2019

American Journal of Transplantation

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“…8 Relative consensus exists that patients with recurrent IgAN should mainly receive optimized supportive care. A small case series 86 reported that without reninangiotensin blockade 4 out of 4 patients with recurrent IgAN progressed to endstage renal disease compared with 3 out of 9 in the group treated with an ARB. Whether patients with recurrent IgAN should also receive a tonsillectomy, as suggested by a recent small Japanese trial, is currently unresolved.…”

Section: The Patient With Overt Nephrotic Syndromementioning

confidence: 99%

Current Therapy for IgA Nephropathy

Floege

Eitner

2011

Journal of the American Society of Nephrology

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“…The KDIGO transplant guidelines recommend ancillary management aimed at reducing proteinuria and controlling blood pressure by the use of angiotensin converting enzyme inhibitors or angiotensin II receptor blockers . The results of two small single‐centre studies have supported this practice; however, evidence for its effectiveness in minimizing proteinuria or improving graft survival in recurrent IgAN is lacking …”

Section: Prognosis and Treatment Of Post‐transplant Igad And Iganmentioning

confidence: 99%

Post‐transplant immunoglobulin A deposition and nephropathy in allografts

et al. 2018

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Post-transplant immunoglobulin A (IgA) nephropathy (IgAN) in the allograft is the major cause of allograft loss. Using a protocol biopsy, latent mesangial IgA deposition (IgAD) can be detected in the allograft. Latent IgAD is distinguished from IgAN by the absence of urinary abnormalities, although IgA is observed in the mesangium. However, the pathophysiology and most appropriate treatment strategy for latent mesangial IgAD in the allograft remain to be fully determined. Importantly, it is unknown whether all cases of post-transplant asymptomatic IgAD progress to symptomatic IgAN; indeed, IgA deposits disappear in some cases. The differences in allograft prognosis between asymptomatic IgAD and IgAN have also not been determined. Non-invasive methods of diagnosis of IgAD in the allograft using serological and pathological biomarkers are being developed. Possible serum biomarkers include serum galactose-deficient IgA1 (Gd-IgA1), Gd-IgA1-specific IgG and Gd-IgA1-specific IgA, and its immune complexes. Immunofluorescence analysis using Gd-IgA1 monoclonal antibody may provide a pathological biomarker. These serological and pathological biomarkers may be suitable for the characterization of the stage of IgAD. However, there is insufficient information regarding whether serological and pathological biomarkers can predict the progression of asymptomatic IgAD to symptomatic IgAN. We propose that the pathogenesis of IgAN can be defined through the clinical study of IgAD in the allograft using protocol biopsies conducted by nephrologists involved in clinical kidney transplantation.

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Does angiotensin blockade influence graft outcome in renal transplant recipients with IgA nephropathy?

Abstract: In transplant recipients with ESRD due to biopsy-proven IgAN, a trend towards improved 5-year and 10-year graft survival was seen in those prescribed ACEi/ARBs. All with recurrent IgAN in their grafts who were not treated with ACEi/ARB therapy progressed again to ESRD.

Cited by 47 publications

References 18 publications

Clinical importance of the updated Oxford classification in allograft IgA nephropathy

Clinical importance of the updated Oxford classification in allograft IgA nephropathy

Current Therapy for IgA Nephropathy

Post‐transplant immunoglobulin A deposition and nephropathy in allografts

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