Predictors for the recurrence of IgA disease following renal transplantation.
ASN 30th Annual Meeting, San Antonio
J Am Soc Nephrol (Oct) 8:704A 1997
IgA nephropathy is recognized as the most common primary glomerular disease in the world. Initially seen as benign, it is now known that as many as one third of patients develop end-stage renal disease ten years after diagnosis (Donadio and Grande, JASN 8:1324, 1997). Patients with IgA nephropathy are, in general, excellent candidates for transplantation, however the disease may recur in the allograft. Just as the course of the primary disease is recognized as progressive in some patients, the course of recurrent disease is increasingly seen as a cause of allograft dysfunction.
Stack, et al., in a retrospective study, examined the clinical course of 44 allografts in 42 patients with IgA nephropathy. They attempted to correlate the rate of recurrence with the severity of original disease at presentation. Of the 42 patients, 62% had severe disease at presentation, 26% moderate and 5% mild. Those with severe disease had the most rapid progression to end stage renal disease. 21 of the 44 allografts were biopsied, although indications are not described in the abstract. 24% (5) of allograft biopsies revealed recurrent IgA nephropathy and 4 patients (9% of the total) lost their grafts to recurrent diseases. The time of follow-up was a mean of 43 months. Recurrence of disease was only noted in patients whose initial disease was moderate or severe and the progression was more rapid in the severe group. The authors conclude that the prevalence of recurrent IgA is less than others have reported and that the course in the allograft mimics the original disease.
Comment: The authors report a finding of potential significance, that the risk and severity of recurrent IgA nephropathy may correlate with the course and pathology of the original disease. Their conclusions regarding the recurrence rate of the disease are less valid because they did not biopsy all patients, as others have. Nevertheless, the ablility to stratify risk for recurrent disease might eventually be helpful as treatment strategies are identified. (Judith Benstein, M.D., NYU University Hospital, New York, NY)
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ASN 30th Annual Meeting, San Antonio
Transplant : Transplantation