Recurrent IgA nephropathy complicated with Crohn’s disease after renal transplantation

Hasegawa, Midori; Sasaki, Hidetada; Takahashi, Kazuo; Hayashi, Hiroki; Koide, Shigehisa; Tomita, Makoto; Takeda, Asami; Hoshinaga, Kiyotaka

doi:10.1007/s13730-014-0111-8

Cited by 2 publications

(1 citation statement)

References 24 publications

(26 reference statements)

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“…Blood flow in arteries with severe hyalinosis due to CNI toxicity has been reported to be approximately 20% of that in normal arteries [ 38 ], leading to interstitial fibrosis. Indeed, associations between the duration of CsA administration and graft loss/poor graft function had been reported previously [ 31 ]. The prevalent interstitial fibrosis observed in our study (∼70% with positive ci scores), probably due to CNI, can explain the steepness of eGFR slopes (∼−3 mL/min/1.73 m 2 /year) after biopsy even in patients with treatment modification.…”

Section: Discussionmentioning

confidence: 72%

Clinical Impacts of Allograft Biopsy in Renal Transplant Recipients 10 Years or Longer After Transplantation

Namba-Hamano,

Hamano,

Doi

et al. 2024

Transpl Int

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We aimed to investigate the clinical value of allograft biopsy performed long after renal transplantation. We retrospectively evaluated 99 allograft biopsies in recipients with transplantation vintages of 10 years or longer. Mixed-effects model showed that 1-year estimated glomerular filtration rate (eGFR) slopes after biopsy were significantly greater than those before biopsy [−3.13, −4.42 mL/min/1.73 m2/year, p = 0.01]. Renal biopsy changed the treatment strategies in more than half of the patients. Improvement in eGFR slopes was pronounced in 51 patients with treatment modification based on the biopsy results [2.27 (95% confidence interval (CI): 0.66, 3.89) mL/min/1.73 m2/year], whereas no improvement was observed in those without [0.33 (95% CI: −1.05, 1.71) mL/min/1.73 m2/year, Pinteraction = 0.001]. Among the treatment modifications, enhancement of immunosuppression (IS) led to the most remarkable improvement in eGFR slope. Patients with g scores ≥2 were more likely to receive IS enhancement than those with g scores = 0 [odds ratio; 15.0 (95% CI: 1.65, 136)]. Patients with active glomerulitis (g ≥ 1) without chronicity (cg ≤ 1) showed the most significant improvement in eGFR slope. Given the prevalence of active glomerulitis (g ≥ 1, 21%), which is responsive to treatment even long after transplantation, and the observed magnitude of eGFR slope improvement, renal biopsy can indeed improve allograft prognosis.

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Section: Discussionmentioning

confidence: 72%