IgA NEPHROPATHY IN PATIENTS RECEIVING A RENAL TRANSPLANT

• Published in: Journal of renal care Vol. 41; no. 4; pp. 222 - 230
• Main Authors: Lemes-Canuto, Ana Paula Pereira Santana, de Sandes-Freitas, Tainá Veras, Medina-Pestana, José Osmar, Mastroianni-Kirsztajn, Gianna
• Format: Journal Article
• Language: English
• Published: United States Blackwell Publishing Ltd 01-12-2015; Wiley Subscription Services, Inc
• Edition: English ed.
• Subjects: Adult; Biopsy; Female; Glomerulonephritis, IGA - diagnosis; Glomerulonephritis, IGA - etiology; Glomerulonephritis, IGA - physiopathology; Graft Survival - physiology; Humans; IgA nephropathy; Immunosuppression; Kidney Transplantation - adverse effects; Male; Middle Aged; Nursing; Patients; Postoperative Complications; Renal transplantation; Retrospective Studies; Survival Rate; Transplants & implants; Young Adult; Brazil; Renal transplantation; Immunosuppression; IgA nephropathy
• ISSN: 1755-6678; 1755-6686
• DOI: 10.1111/jorc.12122

SUMMARY
Background
IgA nephropathy (IgAN) is the third most frequent cause of renal graft loss among patients with primary glomerulonephritis.
Objectives
To assess clinical and laboratorial profile of patients with pre and/or post transplant IgAN, in addition to patient and graft survival in both groups.
Design
Data from 146 patients who had received a renal transplant were retrospectively collected and were divided in two groups: group 1‐patients with biopsy‐documented IgAN as the underlying native kidney disease (n = 128); group 2‐patients who developed post‐transplant IgAN independent of the underlying disease (n = 18).
Participants
Patients submitted to renal transplantation (1998–2010) with pre and/or post transplant IgAN.
Measurements
Clinical and laboratorial evaluation of renal function of 146 post transplant IgAN patients.
Results
Recipients and deceased donors exhibited a higher degree of HLA compatibility (1.0 vs. 2.5 mismatches for groups 1 and 2, respectively). The main post‐transplant IgAN presentation was haematuria associated with non‐nephrotic proteinuria (44.4%). A histological pattern of focal segmental glomerulosclerosis was observed in 59.2% of biopsy samples. The 10‐year patient survival was 93.5% in group 1 and 100% in group 2, and the graft survival rates were 58.5 and 87.2%, respectively.
Conclusion
The rate of post‐transplant IgA diagnosis in our case series was 11%, and IgAN was diagnosed late in the course of transplantation. In most cases, IgAN manifested as haematuria and non‐nephrotic proteinuria, without renal graft dysfunction, and this picture might explain late indication of graft biopsies. The 10‐year patient survival rates were excellent.