Evaluating the Clinical Course and Prognostic Factors of Posttransplantation Immunoglobulin A Nephropathy

Rituximab for recurrent IgA nephropathy in kidney transplantation: A report of three cases and proposed mechanisms

“…7 Regarding the risk factors of ERSD progression, the active pathological lesions such as endocapillary proliferation, fibrinoid necrosis, cellular crescent formation, and global and focal segmental sclerosis have been reported. 8,13 Again, the results from treatment of recurrent IgAN associated with rapid progressive course and crescent formation at biopsy by using high-dose corticosteroids, cyclophosphamide, or plasmapheresis are usually unfavourable. 8 Rituximab is a chimeric monoclonal antibody, which inhibits CD20-mediated B-cell proliferation and differentiation.…”

“…However, the use of corticosteroid treatment requires patient exposure to high doses for a prolonged period, thus increasing the chance for systemic side‐effects including metabolic disturbance, steroid‐induced cataracts and immune suppression consequences. Furthermore, corticosteroid treatment seems to be unable to reverse the highly active and high‐grade severity of tissue pathology such as endocapillary proliferation, crescent formation, and/or thrombotic microangiopathy . We described results for three patients with recurrent IgAN at median duration of 8.4 years (interquartile range (IQR), 14.4) post‐transplantation given rituximab therapy without concomitant corticosteroids.…”

“…Furthermore, corticosteroid treatment seems to be unable to reverse the highly active and high-grade severity of tissue pathology such as endocapillary proliferation, crescent formation, and/or thrombotic microangiopathy. 8 We described results for three patients with recurrent IgAN at median duration of 8.4 years (interquartile range (IQR), 14.4) post-transplantation given rituximab therapy without concomitant corticosteroids. Patient characteristics at baseline are listed in Table 1.…”

Nephrotic-range proteinuria in a patient with a renal allograft treated with sorafenib for metastatic renal-cell carcinoma

“…Indeed de Fijter et al [10] demonstrated that kidneys from old donors are more immunogenic than those from young donors and also have impaired ability to restore tissue. Furthermore, a recent study showed that significant proteinuria (C1 g/day) increases the risk for progressive posttransplantation IgA nephropathy [11]. It is very likely that, in this vulnerable old donor kidney, the dramatic increase in proteinuria contributed to the observed histopathological changes.…”

IgA NEPHROPATHY IN PATIENTS RECEIVING A RENAL TRANSPLANT

“…In 2008 (Kiattisunthorn et al . ) performed a retrospective study involving 30 patients with IgAN confirmed by graft biopsy and also found that abnormalities of urine sediment were the main presentation (96.6%) and 50% of the patients exhibited microscopic hematuria and proteinuria of less than 1 g/day.…”