A rare case of refractory active antibody mediated rejection who had recurrence of immunoglobulin a nephropathy in the form of crescentic glomerulonephritis

Sharon Kandari; Anshuman Biswal; Ravi Kant; Rohit Puri; Parul Ahlawat; Anil Cheriyan; Sandeep Kaur; Abhay Gangdev

doi:10.18203/2320-6012.ijrms20253200

Authors

Sharon Kandari Department of Nephrology, All India institute of medical sciences, Rishikesh, Uttarakhand, India
Anshuman Biswal Department of Nephrology, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
Ravi Kant Department of General Medicine, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
Rohit Puri Department of Nephrology, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
Parul Ahlawat Department of Nephrology, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
Anil Cheriyan Department of Nephrology, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
Sandeep Kaur Department of Nephrology, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
Abhay Gangdev Department of Nephrology, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India

DOI:

https://doi.org/10.18203/2320-6012.ijrms20253200

Keywords:

Cyclophosphamide, Crescentic glomerulonephritis, Refractory active antibody mediated rejection, Recurrent Ig A nephropathy, Steroid

Abstract

Immunoglobulin A nephropathy is one of the most common recurrent glomerulonephritis after kidney transplantation. Recurrence rate is around 30% at 10 years after transplant. Rarely, rapid deterioration of renal function may occur suggestive of presence of crescents. Presence of donor specific antibodies can predict poor transplant outcomes. Compliance to immunosuppressive medications will prevent development of donor specific antibodies and prolong allograft survival. Authors hereby report a case of refractory active antibody mediated rejection who developed recurrent Immunoglobulin A nephropathy 3 years after renal transplantation.

Metrics

Metrics Loading ...

References

Wyatt RJ, Julian BA. IgA nephropathy. N Engl J Med. 2013;368(25):2402–14. DOI: https://doi.org/10.1056/NEJMra1206793

D’Amico G. Natural history of idiopathic IgA nephropathy and factors predictive of disease outcome. In Sem Nephrol. 2004;24(3):179-96. DOI: https://doi.org/10.1016/j.semnephrol.2004.01.001

Ponticelli C, Glassock RJ. Posttransplant recurrence of primary glomerulonephritis. Clinical Journal of the American Soc Nephrol. 2010;5(12):2363-72. DOI: https://doi.org/10.2215/CJN.06720810

Cosio FG, Cattran DC. Recent advances in our understanding of recurrent primary glomerulonephritis after kidney transplantation. Kidney Int. 2017;91(2):304-14. DOI: https://doi.org/10.1016/j.kint.2016.08.030

Allen PJ, Chadban SJ, Craig JC, Lim WH, Allen RD, Clayton PA et al. Recurrent glomerulonephritis after kidney transplantation: risk factors and allograft outcomes. Kidney Int. 2017;92(2):461-9. DOI: https://doi.org/10.1016/j.kint.2017.03.015

Kowalewska J, Yuan S, Sustento-Reodica N, Nicosia RF, Smith KD, Davis CL, et al. IgA nephropathy with crescents in kidney transplant recipients. American J Kid Dis. 2005;45(1):167-75. DOI: https://doi.org/10.1053/j.ajkd.2004.09.030

Jennette JC. Rapidly progressive crescentic glomerulonephritis. Kidney Int. 2003;63(3):1164-77. DOI: https://doi.org/10.1046/j.1523-1755.2003.00843.x

Kawabe M, Yamamoto I, Komatsuzaki Y, Yamakawa T, Katsumata H, Katsuma A, et al. Recurrence and graft loss after renal transplantation in adults with IgA vasculitis. Clin Exp Nephrol. 2017;21(4):714-20. DOI: https://doi.org/10.1007/s10157-016-1336-y

Ponticelli C, Traversi L, Feliciani A, Cesana BM, Banfi G, Tarantino A. Kidney transplantation in patients with IgA mesangial glomerulonephritis. Kidney Int. 2001;60(5):1948-54. DOI: https://doi.org/10.1046/j.1523-1755.2001.00006.x

Di Vico MC, Messina M, Fop F, Barreca A, Segoloni GP, Biancone L. Recurrent IgA nephropathy after renal transplantation and steroid withdrawal. Clin Transplantation. 2018;32(4):13207.

Mousson C, Charon-Barra C, de la Vega MF, Tanter Y, Justrabo E, Martin L, et al. Recurrence of IgA nephropathy with crescents in kidney transplants. In Transplant Proceed. 2007;39(8):2595-6. DOI: https://doi.org/10.1016/j.transproceed.2007.08.025

Uffing A, Pérez-Saéz MJ, Jouve T, Bugnazet M, Malvezzi P, Muhsin SA, et al. Recurrence of IgA nephropathy after kidney transplantation in adults. Clin J Am Soc Nephrol. 2021;16(8):1247-55. DOI: https://doi.org/10.2215/CJN.00910121

Zagkotsis G, Vourlakou C, Paraskevopoulos A, Apostolou T. Recurrence of crescentic IgA nephropathy after renal transplantation. CEN Case Reports. 2018;7(2):268-73. DOI: https://doi.org/10.1007/s13730-018-0341-2

Ortiz F, Gelpi R, Koskinen P, Manonelles A, Räisänen-Sokolowski A, Carrera M, et al. IgA nephropathy recurs early in the graft when assessed by protocol biopsy. Nephrol Dialy Transpl. 2012;27(6):2553-8. DOI: https://doi.org/10.1093/ndt/gfr664

Di Vico MC, Messina M, Fop F, Barreca A, Segoloni GP, Biancone L. Recurrent IgA nephropathy after renal transplantation and steroid withdrawal. Clin Transplant. 2018;32(4):13207. DOI: https://doi.org/10.1111/ctr.13207

Aziz F, Garg N, Singh T, Djamali A, Mandelbrot D. Kidney transplantation for primary glomerulonephritis: recurrence risk and graft outcomes with related versus unrelated donors. Transpl Rev. 2021;1;35(2):100584. DOI: https://doi.org/10.1016/j.trre.2020.100584

Kavanagh CR, Zanoni F, Leal R, Jain NG, Stack MN, Vasilescu ER, et al. Clinical predictors and prognosis of recurrent IgA nephropathy in the kidney allograft. Glomerular Dis. 2022;24;2(1):42-53. DOI: https://doi.org/10.1159/000519834

Suzuki H, Fan R, Zhang Z, Brown R, Hall S, Julian BA, et al. Aberrantly glycosylated IgA1 in IgA nephropathy patients are recognized by IgG antibodies with restricted heterogeneity. J Clin Invest. 2009;119(6):1668-77. DOI: https://doi.org/10.1172/JCI38468

Suzuki Y, Matsuzaki K, Suzuki H, Okazaki K, Yanagawa H, Ieiri N, et al. Serum levels of galactose-deficient immunoglobulin (Ig) A1 and related immune complex are associated with disease activity of IgA nephropathy. Clin Exp Nephrol. 2014;18(5):770-7. DOI: https://doi.org/10.1007/s10157-013-0921-6

Berthoux F, Suzuki H, Mohey H, Maillard N, Mariat C, Novak J, et al. Prognostic value of serum biomarkers of autoimmunity for recurrence of IgA nephropathy after kidney transplantation. J American Soc Nephrol. 2017;28(6):1943-50. DOI: https://doi.org/10.1681/ASN.2016060670

Tang Z, Ji SM, Chen DR, Wen JQ, Chen JS, Liu ZH, et al. Recurrent or de novo IgA nephropathy with crescent formation after renal transplantation. Renal Fail. 2008;30(6):611-6. DOI: https://doi.org/10.1080/08860220802134516

Radhakrishnan J, Cattran DC. The KDIGO practice guideline on glomerulonephritis: reading between the (guide) lines—application to the individual patient. Kidney Int. 2012;82(8):840-56. DOI: https://doi.org/10.1038/ki.2012.280

Lawrence C, Willicombe M, Brookes PA, Santos-Nunez E, Bajaj R, Cook T, et al. Preformed complement-activating low-level donor-specific antibody predicts early antibody-mediated rejection in renal allografts. Transplantation. 2013;95(2):341-6. DOI: https://doi.org/10.1097/TP.0b013e3182743cfa

Filippone EJ, Farber JL. Humoral immune response and allograft function in kidney transplantation. American J Kidney Dis. 2015;66(2):337-47. DOI: https://doi.org/10.1053/j.ajkd.2015.03.033

Guidicelli G, Guerville F, Lepreux S, Wiebe C, Thaunat O, Dubois V, et al. Non-complement–binding de novo donor-specific anti-HLA antibodies and kidney allograft survival. J Am Soc Nephrol. 2016;27(2):615-25. DOI: https://doi.org/10.1681/ASN.2014040326

Ntokou IS, Iniotaki AG, Kontou EN, Darema MN, Apostolaki MD, Kostakis AG, et al. Long‐term follow up for anti‐HLA donor specific antibodies postrenal transplantation: high immunogenicity of HLA class II graft molecules. Transplant Int. 2011;24(11):1084-93. DOI: https://doi.org/10.1111/j.1432-2277.2011.01312.x

Wiebe C, Gibson IW, Blydt-Hansen TD, Karpinski M, Ho J, Storsley LJ, et al. Evolution and clinical pathologic correlations of de novo donor-specific HLA antibody post kidney transplant. American J Transplant. 2012;12(5):1157-67. DOI: https://doi.org/10.1111/j.1600-6143.2012.04013.x

Degner KR, Parajuli S, Aziz F, Garg N, Mohamed M, Mandelbrot DA, et al. Modest improvements in refractory antibody-mediated rejection after prolonged treatment. Kidney Int Rep. 2021;6(5):1397-401. DOI: https://doi.org/10.1016/j.ekir.2021.02.033