Renal transplantation in patients with primary immunoglobulin A nephropathy

Choy, Bo Ying; Chan, Tak Mao; Lo, Sing Kai; Lo, Wai Kei; Lai, Kar Neng

doi:10.1093/ndt/gfg373

Cited by 78 publications

(81 citation statements)

References 15 publications

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“…In the Australia-New Zealand registry, the long-term graft survival was not affected by the increased risk of recurrence in zero-mismatched kidneys (17). In two large Asian reports, the risk of graft loss due to recurrence ranged around 3% to 4% (18,19). However, in the very long term it is possible that recurrent IgAN may represent a substantial risk factor for graft failure.…”

Section: Iganmentioning

confidence: 99%

Posttransplant Recurrence of Primary Glomerulonephritis

Ponticelli

Glassock

2010

Clinical Journal of the American Society of Nephrology

211

166

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All forms of primary GN may recur after kidney transplantation and potentially jeopardize the survival of the graft. IgA nephritis (IgAN) may recur in approximately one third of patients, more frequently in younger patients and in those with a rapid progression of the original disease. However, with the exception of few patients with rapid progression, there is no evidence that recurrence of IgAN has a deleterious effect on graft survival at least up to 10 years. Recurrence of focal segmental glomerulosclerosis (FSGS) is often associated with nephrotic proteinuria and is more frequent in children, in patients with rapid progression of the original disease, and in those who lost a previous transplant from recurrence. The natural course of recurrent FSGS is usually unfavorable. Early and intensive plasmapheresis may obtain complete or partial response in several patients. Good results have also been reported with rituximab. Idiopathic membranous nephropathy (IMN) may recur in 30% to 40% of patients. The graft survival in patients with IMN is not different than that of patients with other renal diseases. Good results with rituximab have been reported. Membranoproliferative GN (MPGN) may recur in 27% to 65% of patients. The recurrence is more frequent and the prognosis is more severe in type II MPGN. Although recurrent GN is relatively frequent and may worsen the outcome of renal allografts in some patients, its effect is diluted by several other risk-factors that may have a greater effect than recurrent GN on the long-term graft survival.

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Section: Iganmentioning

confidence: 99%

Posttransplant Recurrence of Primary Glomerulonephritis

Ponticelli

Glassock

2010

Clinical Journal of the American Society of Nephrology

211

166

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“…Although we do not know the natural course of this patient's IgA nephropathy, recurrent IgA nephropathy generally runs an indolent course with favorable outcome in the first 12 years [6], which contrasts with the observed rapidly progressive course just 3 years post transplant. Third and most interestingly, our patient developed impaired renal function, hypertension and nephrotic-range proteinuria shortly after anti-VEGF therapy began, whereas these disorders improved upon its withdrawal.…”

Section: Discussionmentioning

confidence: 57%

Nephrotic-range proteinuria in a patient with a renal allograft treated with sorafenib for metastatic renal-cell carcinoma

Jonkers

Buren

2009

Clin Exp Nephrol

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A 51-year-old man with immunoglobulin A (IgA) nephropathy developed metastatic renal-cell carcinoma of his native right kidney, 3.5 years post kidney transplant. At that time renal function was stable with the presence of only mild proteinuria. Shortly after chemotherapy with sorafenib [anti-vascular endothelial growth factor (VEGF)] was initiated, progressive renal impairment, hypertension, and nephrotic-range proteinuria developed. Allograft biopsy showed extensive IgA nephropathy. After withdrawal of the anti-VEGF therapy, however, renal function and blood pressure improved, and proteinuria diminished. Based on the clinical course and histopathological findings we hypothesize that sorafenib may induce nephrotic-range proteinuria and renal impairment, possibly through anti-VEGF-mediated effects on the progression of IgA nephropathy.

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“…In those cases, the recurrence rate was between 12.5 and 50%. [6] Importantly, it was found that 52% of the IgAN recurrences diagnosed by protocol biopsies were not accompanied by proteinuria or hematuria. Thus, protocol biopsies with immunofluorescence analysis constitute an essential tool for the diagnosis of recurrence, even if it is clinically silent [7].…”

Section: Discussionmentioning

confidence: 99%