Advertisement

 

 

Successful treatment of recurrent immunoglobulin a nephropathy using steroid pulse therapy plus tonsillectomy 10 years after kidney transplantation: a case presentation.

Successful treatment of recurrent immunoglobulin a nephropathy using steroid pulse therapy plus tonsillectomy 10 years after kidney transplantation: a case presentation.
Author Information (click to view)

Katsumata H, Yamamoto I, Komatsuzaki Y, Kawabe M, Okabayashi Y, Yamakawa T, Katsuma A, Nakada Y, Kobayashi A, Tanno Y, Miki J, Yamada H, Ohkido I, Tsuboi N, Yamamoto H, Yokoo T,


Katsumata H, Yamamoto I, Komatsuzaki Y, Kawabe M, Okabayashi Y, Yamakawa T, Katsuma A, Nakada Y, Kobayashi A, Tanno Y, Miki J, Yamada H, Ohkido I, Tsuboi N, Yamamoto H, Yokoo T, (click to view)

Katsumata H, Yamamoto I, Komatsuzaki Y, Kawabe M, Okabayashi Y, Yamakawa T, Katsuma A, Nakada Y, Kobayashi A, Tanno Y, Miki J, Yamada H, Ohkido I, Tsuboi N, Yamamoto H, Yokoo T,

Advertisement

BMC nephrology 2018 03 1419(1) 64 doi 10.1186/s12882-018-0858-9

Abstract
BACKGROUND
Both prevention and treatment of recurrent immunoglobulin A nephropathy (IgAN) in kidney transplant recipients are important since recurrent IgAN seems to affect long-term graft survival. We present here a case of recurrent IgAN that was successfully treated using steroid pulse therapy plus tonsillectomy 10 years after kidney transplantation.

CASE PRESENTATION
A 46-year-old male was admitted for an episode biopsy with a serum creatinine level of 1.8 mg/dl and proteinuria (0.7 g/day). Histological features showed recurrent IgAN (only focal segmental mesangial proliferation) and severe arteriolar hyalinosis partly associated with calcineurin inhibitor toxicity, with limited interstitial fibrosis and tubular atrophy (5%) (IF/TA) 8 years after transplantation. Sodium restriction and conversion from cyclosporine to tacrolimus successfully reduced his proteinuria to the level of 0.15 g/day. However, 2 years later, his proteinuria increased again (1.0 g/day) and a second episode biopsy showed global mesangial proliferation with glomerular endocapillary and extracapillary proliferation accompanied by progressive IF/TA (20%). The steroid pulse therapy plus tonsillectomy successfully decreased his proteinuria and he achieved clinical remission 3 years after this treatment.

CONCLUSION
This case, presented with a review of relevant literature, demonstrates the difficulty and importance of the treatment of recurrent IgAN and calcineurin inhibitor arteriolopathy, especially in long-term kidney allograft management.

Submit a Comment

Your email address will not be published. Required fields are marked *

ten + 7 =

[ HIDE/SHOW ]