Korean J Transplant.  2022 Nov;36(Supple 1):S340. 10.4285/ATW2022.F-4850.

Successful treatment of recurrent immunoglobulin A nephropathy after kidney transplantation

Affiliations
  • 1Department of Nephrology, Gyeongsang National University Hospital, Jinju, Korea
  • 2Department of Pathology, Gyeongsang National University Hospital, Jinju, Korea

Abstract

Immunoglobulin A nephropathy (IgAN) is the most common type of primary glomerulonephritis and recurrent IgAN is common after kidney transplantation (KT). Here, we report a case of a 60-year-old man with end-stage kidney disease who underwent deceased donor kidney transplantation (DDKT). He was diagnosed with IgAN by kidney biopsy 20 years ago. Three years later, in 2005, he started hemodialysis. He underwent DDKT at another nephrology center 5 years ago. Immunosuppressive therapy consisted of prednisolone, mycophenolate mofetil, and tacrolimus. He was transferred to our hospital 2 years ago for residential reasons. The function of allograft was maintained well. The trough tacrolimus level was adequately maintained at 5–10 ng/mL. Ten months ago, proteinuria was newly found at 0.5 g/g in urine protein/creatinine ratio (UPCR), and then, gradually increased to 1.0 g/g. The patient was admitted for a graft biopsy in January 2022. On admission, his general condition was good and he had normal vitals and euvolemic state. In laboratory analysis, renal function was normal with serum creatinine of 1.06 mg/dL. Cyto-megalovirus and BK viremia were not observed. The trough tacrolimus level was 6.7 ng/mL. On the second day of hospitalization, a kidney allograft biopsy was performed and 500 mg of methylprednisolone was started intravenously for 3 days. We diagnosed a recurrence of IgAN (M1 E0 S0 T0 C0). Afterwards he was discharged with a prescription of 40 mg of oral prednisolone. Out-patient follow-up showed that proteinuria decreased while maintaining steroids, and after adding 80 mg of valsartan on May 11, 2022, proteinuria continued to decrease, resulting in 0.3 g/g of UPCR on August 24, 2022. In this case, we successfully treated recurrent IgAN after DDKT with pulse and oral steroids and valsartan. Kidney biopsy should be considered when new abnormal findings are found. There is no specific treatment for recurrent IgAN after KT. This case is considered of value to the treatment of recurrent IgAN after KT.

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