Loss of Renal Graft due to Recurrent IgA Nephropathy with Rapidly Progressive Course: An Unusual Clinical Evolution

Abstract

Recurrence of IgA nephropathy following renal transplantation has been described in 40–50% of patients, and it usually has a good outcome. We present the case of a 54-year-old man wiht IgA nephropathy who developed terminal renal failure in 1985,3 years after the onset of the disease. In March 1986 he received a cadaveric renal allograft following treatment with ciclosporin and steroids. Eight months later he developed microhaematuria and proteinuria and 10 months later he developed acute nephritic syndrome and rapidly progressive renal failure. Renal biopsy disclosed an IgA nephropathy with epithelial crescents in 60% of glomeruli. Treatment with plasma exchange and cyclophosphamide was unsuccessful and the patient lost his graft and returned to regular haemodialysis 15 months after renal transplantation.

Recurrent or De Novo IgA Nephropathy with Crescent Formation after Renal Transplantation

“…These patients with recurrent IgA nephropathy often presented crescent formation in histology with rapidly progressive renal failure. [9][10][11][12] In this study, we found that our patients had no response or just short time response to intensive immunosuppressive therapy. All of our patients changed their initial immunosuppressive regimens; however, six advanced to renal graft loss within 2 to 12 months, three of them eventually developed ESRD and returned to hemodialysis therapy within two years after kidney transplantation, and only one kept stable graft function for more than three years of follow-up.…”

“…[9][10][11][12] We reported 10 cases that were diagnosed as recurrent or de novo IgA nephropathy with crescent formation. They aged from 25 to 65 years old, and 80% were male.…”

“…[8] Though rare, patients with recurrent IgA nephropathy can present with rapidly progressive glomerulonephritis and subsequent graft loss, characterized by a various degree of crescent formation in histological examination. [9][10][11][12] In this study, we retrospectively analyzed our ten kidney transplanting patients who had renal biopsy proven IgA nephropathy with a different degree of crescentic formation in order to investigate their clinical and pathological features and renal outcome. on those 1,000 recipients.…”

Recurrent IgA Nephropathy in a Renal Allograft Presenting as Crescentic Glomerulonephritis

“…One of these lost his graft from recurrent IgA nephropathy, but not with an acute cres centic course. Further attention as drawn to the possibility of clinically important recur rence by Diaz-Tejeiro et al [2] and despite an initial honeymoon period after plasma ex change and cyclophosphamide treatment, the graft was lost 5 months later. In the patient we have described, the acute glomerulonephritis appeared to have started to resolve prior to the initiation of plasma exchange, so no addi…”

“…Recurrence rates of 38-50% have been described in different mor phological series [1][2][3]. However, there is general agreement that it is rare for such histo logical disease to be clinically important [4.5], Diaz-Tejeiro et al [2] reported a case of recur rent IgA nephropathy having a rapidly pro gressive course and proceeding to graft loss. We report a second case of crescentic IgA nephropathy in a renal allograft and suggest that this complication may not be as unusual as originally thought.…”