Evaluating the clinical course and prognostic factors of posttransplantation immunoglobulin A nephropathy.

Abstract

INTRODUCTION:

Previous reports have suggested that posttransplantation immunoglobulin (Ig) A nephropathy displays a relatively benign course, hardly ever affecting graft function. However, more recent studies with longer follow-up have shown that posttransplantation IgA nephropathy may be a significant contributor to graft loss. Additionally, there may be other clinical or pathological factors that affect long-term graft outcome. We retrospectively analyzed 30 kidney transplant recipients with biopsy-proven IgA nephropathy in their allografts to determine the clinical course and prognostic factors in posttransplantation IgA nephropathy. The median duration of follow-up was 36 months (range, 1 month-17 years). The median onset of IgA nephropathy was 33.6 months posttransplantation (range, 5 days-103 months). The most common presentation was an abnormal urine examination (96.6%). Fifteen (50%) displayed microscopic hematuria with proteinuria more than 1 g/d. Fifteen patients (50%) lost their grafts at a median time of 24 months after the onset of disease (range, 1-93 months). Allograft loss was associated with a high serum creatinine level at the time of diagnosis (3.68 +/- 2.23 vs 1.79 +/- 0.34 mg/dL; P = .006), a greater level of proteinuria at the time of diagnosis (2.43 +/- 0.76 vs 1.29 +/- 1.07 g/d; P = .003), and more than 50% extracapillary proliferation (P = .05). Fibrinoid necrosis on allograft pathology impacted 1-year allograft survival (P = .025).

CONCLUSION:

Posttransplantation IgA nephropathy worsens allograft outcomes among patients with increased serum creatinine level or significant proteinuria at presentation or significant glomerular inflammation and/or tubulointerstitial damage.

• Authors: K Kiattisunthorn, N Premasathian, A Wongwiwatana, P Parichatikanond, B Cheunsuchon, S Vasuvattakul
• Journal: Transplantation proceedings (Transplant Proc) Vol. 40 Issue 7 Pg. 2349-54 (Sep 2008) ISSN: 0041-1345 [Print] United States
• PMID: 18790233 (Publication Type: Journal Article)

Chemical References

• HLA Antigens
• Creatinine

Topics

• Adult
• Blood Pressure
• Cadaver
• Creatinine (blood)
• Female
• Follow-Up Studies
• Glomerulonephritis, IGA (etiology, physiopathology)
• HLA Antigens (immunology)
• Histocompatibility Testing
• Humans
• Kidney Transplantation (adverse effects, immunology)
• Living Donors
• Male
• Middle Aged
• Prognosis
• Proteinuria (etiology)
• Retrospective Studies
• Time Factors
• Tissue Donors