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Diagnosis: IgA Nephropathy (possibly recurrent)

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 (Kawabe M, Yamamoto I. Current status and perspectives on recurrent IgA nephropathy after kidney transplantation. Nephron. 2023. Epub ahead of print. [PubMed link]).

Despite an excellent outcome early after transplantation, almost 50% of recurrent patients experience premature allograft loss. Identifying high-risk patients has been challenging, as the risk of progression to allograft failure is heterogeneous (Bednarova K, et al. A novel prognostic nomogram predicts premature failure of kidney allografts with IgA nephropathy recurrence. Nephrol Dial Transplant. 2023 May 18. Epub ahead of print. [PubMed link]).

See the chapter: IgA Nephropathy of our Tutorial.

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