Renal transplantation in adults with Henoch-Schonlein purpura: long-term outcome

Moroni, Gabriella; Gallelli, Beniamina; Diana, Alessandro; Carminati, Alessia; Banfi, Giovanni; Poli, Francesca; Montagnino, Giuseppe; Tarantino, A

doi:10.1093/ndt/gfn209

Cited by 33 publications

(21 citation statements)

References 16 publications

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“…They showed a graft-survival rate of 95% at 5 years and 87.7% at 10 years for the HSP group, which was not statistically different from their control populations (P ϭ 0.209 for the 10 years survival rate comparison). Similarly Moroni et al (21) reported data on 19 HSP patients requiring renal transplantation over a period of 27 years. After matching 1:2 with controls for age range, gender, and donor source, they found equivalent graft survival with 15 years of follow-up; the death-censored graft-survival rate in the HSP group was 75% at 10 years compared with 70% in the control group (21).…”

Section: Discussionmentioning

confidence: 97%

“…Similarly Moroni et al (21) reported data on 19 HSP patients requiring renal transplantation over a period of 27 years. After matching 1:2 with controls for age range, gender, and donor source, they found equivalent graft survival with 15 years of follow-up; the death-censored graft-survival rate in the HSP group was 75% at 10 years compared with 70% in the control group (21). The remaining four smaller case series reported 5-year allograft survival ranging from 70% to 89% (22)(23)(24)(25)(26).…”

Section: Discussionmentioning

confidence: 97%

“…Previously reported rates of graft loss caused by HSP recurrence have ranged from 0% to 21% (21,23,24,32,33). In their comprehensive review of recurrent glomerulonephritis in renal transplantation, Briganti et al (34) reported an overall incidence of graft loss caused by recurrent disease of 8.4% at 10 years.…”

Section: Discussionmentioning

confidence: 99%

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Long-term Outcome of Renal Transplantation Patients with Henoch-Schönlein Purpura

Samuel¹,

Bell²,

Molony³

et al. 2011

Clinical Journal of the American Society of Nephrology

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SummaryBackground and objectives Although Henoch-Schö nlein purpura (HSP) is the most common form of renal vasculitis in childhood, progression to ESRD is rare, and there are few data on outcomes of renal transplantation in patients with HSP.Design, setting, participants, & measurements This is a matched retrospective cohort study of renal allografts using the United Network of Organ Sharing database (1987 to 2005). Of the 189,211 primary renal allografts, there were 339 with a diagnosis of HSP. The primary end point was allograft survival. ResultsCompared with the remainder of the database, the HSP population was younger (25 years versus 46 years), and had a higher proportion of women (47% versus 40%), live donors (50% versus 35%), and Caucasians (77% versus 60%). Controlling for age, gender, donor source, ethnicity, and year of transplantation, death-censored graft survival for patients with HSP was 80.0% at 5 years and 58.8% at 10 years compared with 79.0% at 5 years and 55.4% at 10 years in the non-HSP population. Among patients with reported causes of graft loss, failure from recurrent disease occurred in 13.6% of patients with HSP, compared with 6.6% in the non-HSP population. When analyzing allograft survival in recipients with HSP compared with those with IgA nephropathy, there was no difference in 10-year allograft survival (58.4% and 59.3%, respectively). ConclusionsThese data indicate that although there is an increased risk of graft failure attributable to recurrent disease in patients with HSP, a diagnosis of HSP has little effect on overall renal allograft survival.

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Section: Discussionmentioning

confidence: 97%

Section: Discussionmentioning

confidence: 97%

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Long-term Outcome of Renal Transplantation Patients with Henoch-Schönlein Purpura

Samuel¹,

Bell²,

Molony³

et al. 2011

Clinical Journal of the American Society of Nephrology

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“…In HSPN, IgA deposition can be found not only in the kidney, but also in other organs, such as the skin. IgA deposition recurs in some patients after renal transplantation [26,27], and after the transplantation of kidneys with mild forms of IgAN, immune complex deposition and nephritic changes decrease and disappear [28], rendering an extrarenal source of IgA very likely. To date, the pathophysiology of IgAN and HSPN seems to be identical, with only quantitative differences, possibly accounting for the different clinical presentation with more acute signs of nephritis in HSPN and a more insidious onset in IgA nephropathy.…”

Section: Etiology and Pathophysiologymentioning

confidence: 99%

Henoch–Schönlein purpura nephritis

Pöhl

2014

Pediatr Nephrol

124

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Henoch-Schönlein purpura (HSP) is the one of most common types of systemic vasculitis in childhood. Glomerulonephritis (HSPN) occurs in 30-50 % of HSP patients, mostly in a mild form but a small percentage of patients present with nephrotic syndrome or renal failure. HSPN is caused by the glomerular deposition of immunoglobulin A1 (IgA1)-containing immune complexes in the mesangium, the subepithelial and the subendothelial space. Formation of the IgA1 immune complex is thought to be the consequence of aberrantly glycosylated IgA1 molecules secreted into the circulation and their subsequent recognition by IgG specific for galactose-deficient IgA1. Mesangial proliferation and renal damage are triggered by the deposited immune complexes, which likely require activation of the complement system. Whereas other organ manifestations of HSP are mostly benign and self-limiting, HSPN might lead to chronic renal disease and end stage renal failure, thereby justifying immunosuppressive treatment. Long-term renal outcome correlates to the severity of the initial clinical presentation and the extent of renal biopsy changes, both of which are used to decide upon a possible treatment. As there are no evidence-based treatment options for severe HSPN, a large variety of therapeutic regimens are used. Prospective randomized controlled treatment studies are needed, but the low incidence of severe HSPN renders such studies difficult.

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“…However, there is a reported 42% recurrence rate, with loss of the graft in half of those patients. 15 Our patient's clinical course highlights the problems associated with evaluating and treating HSP. He has had an extraordinarily labile course with multiple exacerbations and remissions.…”

Section: Discussionmentioning

confidence: 92%

Henoch–Schönlein purpura and recurrent renal failure

et al. 2010

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We present an 18-year-old patient with Henoch-Schönlein purpura (HSP) who had multiple episodes of severe acute renal failure, including one episode for which he required hemodialysis for 2 months and a second episode for which dialysis was considered before his spontaneous recovery of renal function. Multiple treatment options, including steroids, mycophenolate mofetil, cyclophosphamide, and plasmapheresis, were tried but we could not confidently point to the utility of any of these measures. We highlight the unusual severity and lability of our patient's clinical course and how such a course makes the evaluation of treatment effectiveness extraordinarily difficult.

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Renal transplantation in adults with Henoch-Schonlein purpura: long-term outcome

Cited by 33 publications

References 16 publications

Long-term Outcome of Renal Transplantation Patients with Henoch-Schönlein Purpura

Long-term Outcome of Renal Transplantation Patients with Henoch-Schönlein Purpura

Henoch–Schönlein purpura nephritis

Henoch–Schönlein purpura and recurrent renal failure

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