Abstract
The recurrence of IgA nephropathy (IgAN) after kidney transplantation occurs in 20–35% of patients. The main aim of this study is to evaluate risk factors affecting the course of IgAN after renal biopsy of native kidney and kidney transplant. We evaluated clinical parameters and histological findings at the time of biopsy of native kidney and after kidney transplantation in 313 patients with IgAN with a follow-up of up to 36 years. Using hierarchical clustering method, patients with graft failure (n=50) were divided into two groups based on the mean time from kidney transplant to graft failure (11.2 versus 6.1 years). The time-to-graft failure corresponded well to the time from the renal biopsy of native kidney to end-stage renal disease (5.9 versus 0.4 years). Body mass index, proteinuria, microscopic hematuria, histological evaluation of fibrosis, and crescents at the time of renal biopsy of native kidney were the main variables for the differentiation of the two groups. Higher age of kidney-transplant donor, histological recurrence of IgAN, antibody-mediated rejection, and the onset of microscopic hematuria and proteinuria within 1 year after kidney transplant were also associated with worse graft survival in multivariate Cox regression analysis.
Highlights
IgA nephropathy (IgAN) is the most common primary glomerulonephritis with potentially serious outcome leading to end-stage renal disease in 30% to 50% of patients within 20 to 30 years from diagnosis
To better understand the graft function, we evaluated in 313 patients with IgAN who received kidney transplant clinical parameters and histological findings at the time of biopsy of native kidney performed in 1991–2013 and after receiving the kidney transplant in 1996–2017
We evaluated 313 patients with histological diagnosis of IgAN in native kidney biopsies who later received kidney transplants
Summary
IgA nephropathy (IgAN) is the most common primary glomerulonephritis with potentially serious outcome leading to end-stage renal disease in 30% to 50% of patients within 20 to 30 years from diagnosis. The diagnosis of IgAN requires evaluation of a renal biopsy specimen and finding of IgA immunodeposits [1]. Clinical risk factors predicting poor prognosis include time-averaged proteinuria, hypertension, decreased estimated glomerular filtration rate (eGFR) An early initiation of immunosuppressive regimen in patients with IgAN at risk of progression may slow down the progression to end-stage renal disease. Several new treatment options for patients with IgAN are currently under evaluation in clinical trials [7]
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