Crescentic
IgA nephropathy is an uncommon finding in native kidneys (3%-5%) and in renal transplants. This study was performed to determine the frequency of relapsing crescentic
IgA nephropathy after
kidney transplantation. Over a 15-year period, 42 patients (25 men, 17 women) of age range 17 to 59 years with biopsy-proven
IgA nephropathy in their native kidneys were entered into this retrospective study, because they had undergone
kidney transplantation and had sequential allograft biopsies during their follow-up. Mean follow-up after
transplantation was 8.9 years (range, 1-15 years). In their native kidneys, 5 patients (12%) had more than 20% crescents, and only 2 (5%) had more than 50% of glomeruli involved. As expected, 52.4% of recipients showed recurrent mesangial
IgA deposits in their kidney grafts. The 2 patients with diffuse crescentic
IgA nephropathy in their native kidneys experienced acute graft dysfunction at 15 and 47 months. Graft biopsy showed recurrent
IgA deposits with cellular crescents in 30% and 20% of glomeruli, respectively. Despite
corticosteroid pulse
therapy, graft failures occurred 2 and 27 months later. No crescentic proliferation was observed during follow-up in any other case. Only 5 other grafts failed because of chronic allograft nephropathy, without any relationship to the relapse of
IgA deposits. These data suggested for the first time that only diffuse crescentic
IgA nephropathy in the native kidneys was associated with the occurrence of crescents in the kidney transplants, a finding that raises the possibility of a particular subgroup of
IgA nephropathies.