Recurrent IgA nephropathy complicated with Crohn's disease after renal transplantation.

Abstract

A 27-year-old man was diagnosed with IgA nephropathy and Crohn's disease. He had been diagnosed with proteinuria and hematuria since he was 20years old. Diarrhea had been a continuing problem during the past 5months. Neither corticosteroid therapy nor tonsillectomy was performed. Hemodialysis was required at age of 30, while the symptoms of Crohn's disease were ameliorated by an elemental diet. He received a renal transplant from his mother 4months after starting dialysis therapy. The initial immunosuppression therapy consisted of methylprednisolone, mycofenolate mofetil, cyclosporine, and basiliximab. Eight months after transplantation, proteinuria and hematuria appeared and serum creatinine was 1.4mg/dL. Relapse of IgA nephropathy was confirmed by the one-year protocol biopsy. He had suffered from tonsillitis at 32months after the transplantation. Urinary protein increased to 3g/day and serum creatinine was elevated to 2.04mg/dL. Renal biopsy was performed 2weeks after the urinary findings were aggravated. The cellular crescents constituted 36% of the glomeruli. The findings of rejection were not confirmed in both biopsies. Tonsillectomy was performed thereafter. No additional immunosuppressive therapy was added. Proteinuria and hematuria disappeared at 4 and 20months, respectively, after tonsillectomy, even when the symptoms of Crohn's disease worsened 69months and 89months after transplantation. A renal biopsy was performed 101months after transplantation. Although IgA in the mesangium area was confirmed by immunohistochemical staining, no active lesion was seen. Tonsillectomy along with immunosuppressants for the graft might be an effective treatment for some patients with active recurrent IgA nephropathy.