IgA nephropathy: Recurrence after transplantation
- Rowena Delos Santos, MD
Rowena Delos Santos, MD
- Assistant Professor of Medicine
- Washington University in St. Louis
- Daniel C Brennan, MD, FACP
Daniel C Brennan, MD, FACP
- Editor-in-Chief — Nephrology
- Section Editor — Renal Transplantation
- Professor of Medicine
- Medical Director and Co-Director of the Comprehensive Transplant Center, Department of Internal Medicine, Division of Nephrology
- Johns Hopkins Medical School
Transplantation is the treatment of choice for individuals with progressive renal failure due to IgA nephropathy (IgAN), which is caused by the deposition of IgA in the kidney parenchyma. Recurrent IgA deposition in the allograft is common and may cause hematuria, proteinuria, or progressive renal dysfunction. Among some patients, however, IgA deposits are observed on biopsy, but do not appear to cause clinically significant disease. . IgA deposition may occur alone or be concurrent with other significant pathology, including chronic rejection.
Issues related to recurrence after transplantation in patients with IgAN or Henoch-Schönlein purpura (IgA vasculitis [IgAV] or HSP) are reviewed here. The pathogenesis, treatment, and prognosis of this disorder are discussed separately. (See "Pathogenesis of IgA nephropathy" and "Treatment and prognosis of IgA nephropathy".)
There have been no large, prospective studies defining the risk of recurrence in patients with IgAN who receive either a living-donor or deceased-donor renal allograft. The reported frequency of histologic or clinically significant recurrence of IgAN varies in the reported literature, with the incidence probably increasing as a function of time from transplantation [2-4].
Histologic recurrence, with or without evidence of clinical disease, is common. As an example, in a combined retrospective and prospective study that reviewed biopsies from 29 allografts, histologic recurrence of IgA deposition was found in 17 patients (58 percent) . Three of these patients had a normal urinalysis and normal glomeruli on light microscopy, while five had hematuria, heavy proteinuria, hypertension, and progressive renal failure due to IgAN alone. The only predictor for recurrence was a longer time after transplantation (46 versus 15 months in those without recurrence).
In retrospective analyses of allograft biopsies obtained due to clinical concern for graft dysfunction, the recurrence of IgAN has ranged from 21 to 58 percent [5-10].
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- RISK FACTORS
- Donor effect
- Human leukocyte antigen effect
- Serum IgA concentration
- CLINICAL MANIFESTATIONS
- Markers for progression
- HENOCH-SCHÖNLEIN PURPURA (IgA VASCULITIS)
- OTHER CAUSES OF GLOMERULAR IgA DEPOSITION
- TRANSPLANTATION OF A KIDNEY WITH IgA DEPOSITS
- SUMMARY AND RECOMMENDATIONS