Successful treatment of recurrent immunoglobulin a nephropathy using steroid pulse therapy plus tonsillectomy 10 years after kidney transplantation: a case presentation

Katsumata, Haruki; Yamamoto, Izumi; Komatsuzaki, Yo; Kawabe, Mayuko; Okabayashi, Yusuke; Yamakawa, Takafumi; Katsuma, Ai; Nakada, Yasuyuki; Kobayashi, Adam; Tanno, Yudo; Miki, Jun; Yamada, Hiroki; Ohkido, Ichiro; Tsuboi, Nobuyuki; Yamamoto, Hiroyasu; Yokoo, Takashi

doi:10.1186/s12882-018-0858-9

Cited by 6 publications

(5 citation statements)

References 29 publications

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“…Various treatment strategies have been tried with poor outcomes, including pulse steroids, cyclophosphamide per os, plasma exchange and intensification of immunosuppressive regimen [7,10]. Recently, Herzog et al reported the use of eculizumab with no effect [19], while Katsumata et al presented a patient with crescents in only 10% of the glomeruli, that achieved remission with tonsillectomy and steroid pulse therapy [20]. Our patient received pulse steroids and six monthly doses of intravenous cyclophosphamide.…”

Section: Discussionmentioning

confidence: 83%

“…The presence of crescents is even rarer in allograft kidneys, although it has been reported in 4-14% of recurrent or de novo allograft IgAN in Asian patients [9,10]. Several case reports [11][12][13][14][15][16][17][18][19][20] and two case series have been published [7,10] (Table 1). It appears to be a male predominance and the only factor associated with the development of crescentic IgAN is the presence of IgAN in native kidneys that led to ESRD [7,10].…”

Section: Discussionmentioning

confidence: 99%

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Recurrence of crescentic IgA nephropathy after renal transplantation

Zagkotsis¹,

Vourlakou²,

Paraskevopoulos³

et al. 2018

CEN Case Rep

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IgA nephropathy (IgAN) is one of the most common recurrent glomerulonephritis after renal transplantation. Rarely, it is accompanied with the presence of crescents that leads to rapid deterioration of renal function and graft loss. We present a 54-year-old patient with IgAN that received a cadaveric kidney allograft, but developed biopsy proven recurrent IgAN 7 months after renal transplantation. He was treated with intravenous steroids and angiotensin-converting enzyme inhibitor and remission was achieved. 4 years later, he presented again with heavy proteinuria, hematuria and deterioration of renal function. Allograft biopsy revealed recurrent IgAN with crescents, which was successfully treated with pulse intravenous steroids and six monthly doses of intravenous cyclophosphamide. This regime resulted in long-term sustained remission with a stable functioning graft 3 years later. Although it is not an established treatment as in native kidneys, intravenous cyclophosphamide should probably be considered in kidney transplants with potentially reversible recurrent crescentic IgAN.

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Section: Discussionmentioning

confidence: 83%

Section: Discussionmentioning

confidence: 99%

Recurrence of crescentic IgA nephropathy after renal transplantation

Zagkotsis¹,

Vourlakou²,

Paraskevopoulos³

et al. 2018

CEN Case Rep

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“…No established therapy is currently available for recurrent IgAN. However, some Japanese researchers reported the efficacy of tonsillectomy with or without methylprednisolone pulse therapy for recurrent IgAN [ 30 – 33 ]. These studies show that tonsillectomy has improved hematuria, proteinuria, and pathological manifestations.…”

Section: Discussionmentioning

confidence: 99%

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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“…Patients with higher TLR9 expression in the tonsils had a lower serum Gd-IgA1 level, and hematuria improved immediately after tonsillectomy [37]. Similarly, for IgAN patients undergoing kidney transplantation, tonsillectomy has also been reported to decrease proteinuria and induce clinical remission in recurrent IgAN or IgA vasculitis [38][39][40][41]. However, tonsillectomy did not improve the outcomes of kidney transplantation in European IgAN, suggesting that the underlying mechanisms of Gd-IgA1 production may differ among ethnic groups.…”

Section: Perspectives On Preventive and Therapeutic Strategies For Ig...mentioning

confidence: 99%

Current Status and Perspectives on Recurrent IgA Nephropathy after Kidney Transplantation

Kawabe¹,

Yamamoto²

2023

Nephron

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IgA nephropathy (IgAN) is the most common form of glomerulonephritis worldwide. IgAN progresses to end-stage kidney disease in 20-40% of patients within 20 years of diagnosis. Kidney transplantation is the most effective option for patients with end-stage kidney disease caused by IgAN, but recurrence can occur in the transplanted kidney. The IgAN recurrence rate varies from 1% to 10% per year, and varies according to the follow-up period, diagnostic modality, and biopsy criteria. Of note, studies based on protocol biopsies have reported a higher incidence of recurrence, which also occurred earlier after transplantation. In addition, recent data show that recurrence of IgAN is a more significant cause of allograft failure than previously believed. Little is known about the pathophysiology of IgAN recurrence, but several potential biomarkers have been investigated. Among them, galactose-deficient IgA1 (Gd-IgA1), IgG anti-Gd-IgA1 antibodies, and soluble CD89 could play a pivotal role in disease activity. This review aims to describe the current status of recurrent IgAN, including the incidence, clinical characteristics, risk factors, and future perspectives, with a focus on the available therapeutic approaches.

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Successful treatment of recurrent immunoglobulin a nephropathy using steroid pulse therapy plus tonsillectomy 10 years after kidney transplantation: a case presentation

Cited by 6 publications

References 29 publications

Recurrence of crescentic IgA nephropathy after renal transplantation

Recurrence of crescentic IgA nephropathy after renal transplantation

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

Current Status and Perspectives on Recurrent IgA Nephropathy after Kidney Transplantation

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