Recurrence of crescentic IgA nephropathy after renal transplantation

Glomerulonephritis (GN) continues to be one of the main causes of end-stage kidney disease (ESKD) with an incidence rating from 10.5% to 38.2%. Therefore, recurrent GN, previously considered to be a minor contributor to graft loss, is the third most common cause of graft failure 10 years after renal transplantation. However, the incidence, pathogenesis, and natural course of recurrences are still not completely understood. This review focuses on the most frequent diseases that recur after renal transplantation, analyzing rate of recurrence, epidemiology and risk factors, pathogenesis and bimolecular mechanisms, clinical presentation, diagnosis, and therapy, taking into consideration the limited data available in the literature. First of all, the risk for recurrence depends on the type of glomerulonephritis. For example, recipient patients with anti-glomerular basement membrane (GBM) disease present recurrence rarely, but often exhibit rapid graft loss. On the other hand, recipient patients with C3 glomerulonephritis present recurrence in more than 50% of cases, although the disease is generally slowly progressive. It should not be forgotten that every condition that can lead to chronic graft dysfunction should be considered in the differential diagnosis of recurrence. Therefore, a complete workup of renal biopsy, including light, immunofluorescence and electron microscopy study, is essential to provide the diagnosis, excluding alternative diagnosis that may require different treatment. We will examine in detail the biomolecular mechanisms of both native and transplanted kidney diseases, monitoring the risk of recurrence and optimizing the available treatment options.

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“…Recurrence more often occurs 3 years after transplantation, reducing the graft survival only in the long term [ 53 ].…”

Section: Primary Gn Iga Nephropathy (Igan)mentioning

confidence: 99%

Recurrent Glomerulonephritis after Renal Transplantation: The Clinical Problem

Infante

Rossini

Leo

et al. 2020

IJMS

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“…The current practice is to maintain (or change to) a calcineruin-inhibitor (CNI) and corticosteroids-based immunosuppressive regimen in addition to anti-proteinuric treatments, although the optimal dosing/target therapeutic CNI level or specific CNI type in the treatment of those with recurrent disease remains unknown (Table 3). In cases of crescentic rapidly progressive IgA nephropathy, more aggressive immunosuppression (e.g., cyclophosphamide or rituximab) may be considered but this is largely unproven and unlikely to successfully reverse the disease process (53–56). The potential benefit of tonsillectomy in disease recurrence has been limited to case reports and therefore cannot be recommended as a treatment option for patients with recurrent IgA nephropathy (57, 58).…”

Section: Introductionmentioning

confidence: 99%

Recurrent and de novo Glomerulonephritis After Kidney Transplantation

2019

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The prevalence, pathogenesis, predictors, and natural course of patients with recurrent glomerulonephritis (GN) occurring after kidney transplantation remains incompletely understood, including whether there are differences in the outcomes and advances in the treatment options of specific GN subtypes, including those with de novo GN. Consequently, the treatment options and approaches to recurrent disease are largely extrapolated from the general population, with responses to these treatments in those with recurrent or de novo GN post-transplantation poorly described. Given a greater understanding of the pathogenesis of GN and the development of novel treatment options, it is conceivable that these advances will result in an improved structure in the future management of patients with recurrent or de novo GN. This review focuses on the incidence, genetics, characteristics, clinical course, and risk of allograft failure of patients with recurrent or de novo GN after kidney transplantation, ascertaining potential disparities between “high risk” disease subtypes of IgA nephropathy, idiopathic membranous glomerulonephritis, focal segmental glomerulosclerosis, and membranoproliferative glomerulonephritis. We will examine in detail the management of patients with high risk GN, including the pre-transplant assessment, post-transplant monitoring, and the available treatment options for disease recurrence. Given the relative paucity of data of patients with recurrent and de novo GN after kidney transplantation, a global effort in collecting comprehensive in-depth data of patients with recurrent and de novo GN as well as novel trial design to test the efficacy of specific treatment strategy in large scale multicenter randomized controlled trials are essential to address the knowledge deficiency in this disease.

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“…Zagkotsis et al reported successful treatment and long-term remission in a patient with recurrent post-transplant IgA nephropathy treated with steroids and cyclophosphamide. 17 Gopalakrishnan et al report a good response to pulse steroids and intravenous cyclophosphamide in a case of recurrent crescentic IgA nephropathy in which 56% of glomeruli showed crescent formation. 18 We chose not to use cyclophosphamide in our case due to the high likelihood of nonreversibility of kidney transplant dysfunction given the extent of pathologic findings, as well as concern for excessive immunosuppression.…”

Section: Discussionmentioning

confidence: 99%

“…There are, however, reports of successful treatment of recurrent post‐transplant crescentic IgA nephropathy with cyclophosphamide‐containing regimen. Zagkotsis et al reported successful treatment and long‐term remission in a patient with recurrent post‐transplant IgA nephropathy treated with steroids and cyclophosphamide . Gopalakrishnan et al report a good response to pulse steroids and intravenous cyclophosphamide in a case of recurrent crescentic IgA nephropathy in which 56% of glomeruli showed crescent formation .…”

Section: Discussionmentioning

confidence: 99%