Skip to main content

Advertisement

SpringerLink
Log in

Treatment protocol with pulse and oral steroids for IgA Nephropathy after kidney transplantation

  • Original Article
  • Published:
Journal of Nephrology Aims and scope Submit manuscript

Abstract

Background

No specific treatment for IgA nephropathy (IgAN) after kidney transplantation is currently available.

Methods

We conducted a retrospective single-center study on 29 patients with biopsy-proven de novo and recurrent IgAN after kidney transplantation, divided into two groups. Group 1 (n = 16) received intravenous methylprednisolone 500 mg per day for three consecutive days at the beginning of months 1, 3 and 5, plus oral prednisone 0.5 mg/kg every other day for 6 months. The control group (n = 13, Group 2) received supportive therapies.

Results

The two groups were comparable for serum creatinine (sCr) and proteinuria at the time of renal biopsy, but differed significantly at the end of follow-up. sCr was 1.8 ± 0.4 mg/dl in Group 1 vs. 2.7 ± 0.9 in Group 2 (p = 0.002), and proteinuria was 0.9 g/day in Group 1 vs. 1.9 in Group 2 (p = 0.04). The composite outcome of death-censored graft loss or doubling of sCr displayed 2 events in Group 1 (12.5 % of the entire group) and 5 events in Group 2 (38.5 % of the entire group), p = 0.19, odds ratio (OR) 4.4 [95 % confidence interval (CI) 0.7–27.8].

Conclusions

In the absence of therapeutic guidelines for de novo or recurrent IgAN after kidney transplantation, our study reports that therapy with pulse and oral steroids for 6 months is associated with an improved renal function. Nevertheless, further randomized controlled studies in larger patient cohorts are necessary to establish the gold standard treatment.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Koyama A, Igarashi M, Kobayashi M (1997) Natural history and risk factors for immunoglobuline A nephropathy in Japan. Research Group on Progressive Renal Diseases. Am J Kidney Dis 4:526–532

    Article  Google Scholar 

  2. Berger J (1998) Recurrence of IgA nephropathy in renal allografts. Am J Kidney Dis 12:371–372

    Article  Google Scholar 

  3. Von Visger JR, Gunay Y, Andreoni KA et al (2014) The risk of recurrent IgA nephropathy in a steroid-free protocol and other modifying immunosuppression. Clin Transplant 28(8):845–854

    Article  Google Scholar 

  4. Ortiz F, Gelpi R, Koskinen P et al (2012) IgA nephropathy recurs early in the graft when assessed by protocol biopsy. Nephrol Dial Transplant 27:2553–2558

    Article  CAS  PubMed  Google Scholar 

  5. Briganti EM, Russ GR, McNeil JJ, Atkins RC, Chadban SJ (2002) Risk of renal allograft loss from recurrent glomerulonephritis. N Engl J Med 347:103–109

    Article  PubMed  Google Scholar 

  6. Floege J, Gröne HJ (2013) Recurrent IgA nephropathy in the renal allograft: not a benign condition. Nephrol Dial Transplant 28(5):1070–1073

    Article  PubMed  Google Scholar 

  7. Moroni G, Longhi S, Quaglini S et al (2013) The long-term outcome of renal transplantation of IgA nephropathy and the impact of recurrence on graft survival. Nephrol Dial Transplant 28:1305–1314

    Article  CAS  PubMed  Google Scholar 

  8. Mulay AV, Van Walraven C, Knoll GA (2009) Impact of immunosuppressive medication on the risk of renal allograft failure due to recurrent glomerulonephritis. Am J Transplant 9:804–811

    Article  CAS  PubMed  Google Scholar 

  9. Clayton P, McDonald S, Chadban S (2011) Steroids and recurrent IgA nephropathy after kidney transplantation. Am J Transplant 11:1645–1649

    Article  CAS  PubMed  Google Scholar 

  10. Kukla A, Chen E, Spong R et al (2011) Recurrent glomerulonephritis under rapid discontinuation of steroids. Transplantation 91:1386–1391

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  11. Pozzi C, Andrulli S, Del Vecchio L et al (2004) Corticosteroid effectiveness in IgA Nephropathy: long-term results of a randomized, controlled trial. J Am Soc Nephrol 15:157–163

    Article  CAS  PubMed  Google Scholar 

  12. Pozzi C, Balasco PG, Fogazzi GB et al (1999) Corticosteroids in IgA nephropathy; a randomised controlled trial. Lancet 353:883–887

    Article  CAS  PubMed  Google Scholar 

  13. Working Group of the International IgA Nephropathy Network and the Renal Pathology Society, Cattran DC, Coppo R et al (2009) The Oxford Classification of IgA nephropathy: rationale, clinicopathological correlations, and classification. Kidney Int 76(5):534–545

    Article  Google Scholar 

  14. Coppo R, Troyanov S, Bellur S et al (2014) Validation of the Oxford Classification of IgA nephropathy in cohorts with different presentations and treatments. Kidney Int 86(4):828–836

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  15. Morozumi K, Takeda A, Otsuka Y et al (2014) Recurrent glomerular disease after kidney transplantation: an update of selected areas and the impact of protocol biopsy. Nephrology 19(Suppl 3):6–10

    Article  PubMed  Google Scholar 

  16. Oka K, Imai E, Moriyama T et al (2000) A clinicopathological study of IgA nephropathy in renal transplant recipients: beneficial effect of angiotensin-converting enzyme inhibitor. Nephrol Dial Transplant 15:689–695

    Article  CAS  PubMed  Google Scholar 

  17. Kidney Disease: Improving Global Outcomes (KDIGO) Glomerulonephritis Work Group (2012) KDIGO clinical practice guideline for glomerulonephritis. Kidney Int Suppl 2(2):139–274

    Article  Google Scholar 

  18. Courtney AE, McNamee PT, Nelson WE, Maxwell AP (2006) Does angiotensin blockade influence graft outcome in renal transplant recipients with IgA nephropathy? Nephrol Dial Transplant 21:3550–3554

    Article  CAS  PubMed  Google Scholar 

  19. Ng R (2003) Fish oil therapy in recurrent IgA nephropathy. Ann Intern Med 138:1011–1012

    Article  PubMed  Google Scholar 

  20. Hotta K, Fukasawa Y, Akimoto M et al (2013) Tonsillectomy ameliorates histological damage of recurrent immunoglobulin A nephropathy after kidney transplantation. Nephrology 18:808–812

    Article  PubMed  Google Scholar 

  21. Kennoki T, Ishida H, Yamaguchi Y, Tanabe K (2009) Proteinuria-reducing effects of tonsillectomy alone in IgA nephropathy recurring after kidney transplantation. Transplantation 88:935–941

    Article  PubMed  Google Scholar 

  22. Koshino K, Ushigome H, Sakai K et al (2013) Outcome of tonsillectomy for recurrent IgA nephropathy after kidney transplantation. Clin Transpl 27:22–28

    Article  Google Scholar 

  23. Ziswiler R, Steinmann-Niggli K, Kappeler A, Daniel C, Marti HP (1998) Mycophenolic acid: a new approach to the therapy of experimental mesangial proliferative glomerulonephritis. J Am Soc Nephrol 9(11):2055–2066

    CAS  PubMed  Google Scholar 

  24. Chandrakantan A, Ratanapanichkich P, Said M, Barker CV, Julian BA (2005) Recurrent IgA nephropathy after renal transplantation despite immunosuppressive regimens with mycophenolate mofetil. Nephrol Dial Transplant 20:1214–1221

    Article  CAS  PubMed  Google Scholar 

  25. Liang Y, Zhang J, Liu D et al (2014) Retrospective study of mycophenolate mofetil treatment in IgA nephropathy with proliferative pathological phenotype. Chin Med J 127(1):102–108

    CAS  PubMed  Google Scholar 

  26. Frisch G, Lin J, Rosenstock J et al (2005) Mycophenolate mofetil (MMF) vs placebo in patients with moderately advanced IgA nephropathy: a double-blind randomized controlled trial. Nephrol Dial Transplant 20(10):2139–2145

    Article  CAS  PubMed  Google Scholar 

  27. Manno C, Torres DD, Rossini M, Pesce F, Schena FP (2009) Randomized controlled clinical trial of corticosteroids plus ACE inhibitors with long term follow-up in proteinuric IgA nephropathy. Nephrol Dial Transplant 24:3694–3701

    Article  CAS  PubMed  Google Scholar 

  28. Lv J, Xu D, Perkovic V et al (2012) Corticosteroid therapy in IgA nephropathy. J Am Soc Nephrol 23:1108–1116

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  29. Tesar V, Troyanov S, Bellur S, VALIGA study of the ERA-EDTA Immunonephrology Working Group et al (2015) Corticosteroids in IgA nephropathy: a retrospective analysis from the VALIGA study. J Am Soc Nephrol 26:2248–2258

    Article  CAS  PubMed  Google Scholar 

  30. Ibrahim H, Rogers T, Casingal V et al (2006) Graft loss from recurrent glomerulonephritis is not increased with a rapid steroid discontinuation. Transplantation 81(2):214–219

    Article  PubMed  Google Scholar 

  31. Wyld ML, Chadban SJ (2016) Recurrent IgA nephropathy after kidney transplantation. Transplantation [Epub ahead of print]

Download references

Author information

Author notes

    Authors and Affiliations

    1. Renal Transplantation Unit ‘A. Vercellone’, Division of Nephrology Dialysis and Transplantation, Department of Medical Sciences, Città della Salute e della Scienza Hospital and University of Turin, Cso Bramante 88, 10126, Turin, Italy

      Maria Messina, Maria Cristina di Vico, Claudia Ariaudo, Fabrizio Fop, Giuseppe Paolo Segoloni & Luigi Biancone

    2. Division of Pathology, Department of Medical Sciences, University of Turin, Turin, Italy

      Gianna Mazzucco

    Authors
    1. Maria Messina
      View author publications

      You can also search for this author in PubMed Google Scholar

    2. Maria Cristina di Vico
      View author publications

      You can also search for this author in PubMed Google Scholar

    3. Claudia Ariaudo
      View author publications

      You can also search for this author in PubMed Google Scholar

    4. Gianna Mazzucco
      View author publications

      You can also search for this author in PubMed Google Scholar

    5. Fabrizio Fop
      View author publications

      You can also search for this author in PubMed Google Scholar

    6. Giuseppe Paolo Segoloni
      View author publications

      You can also search for this author in PubMed Google Scholar

    7. Luigi Biancone
      View author publications

      You can also search for this author in PubMed Google Scholar

    Corresponding author

    Correspondence to Luigi Biancone.

    Ethics declarations

    Conflict of interest

    On behalf of all authors, the corresponding author states that there is no conflict of interest.

    Ethical approval

    All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. This article does not contain any studies with animals performed by any of the authors.

    Additional information

    M. Messina and M. C. di Vico equally contributed to the study.

    Rights and permissions

    Reprints and permissions

    About this article

    Check for updates. Verify currency and authenticity via CrossMark

    Cite this article

    Messina, M., di Vico, M.C., Ariaudo, C. et al. Treatment protocol with pulse and oral steroids for IgA Nephropathy after kidney transplantation. J Nephrol 29, 575–583 (2016). https://doi.org/10.1007/s40620-016-0314-5

    Download citation

    • Received:

    • Accepted:

    • Published:

    • Issue Date:

    • DOI: https://doi.org/10.1007/s40620-016-0314-5

    Keywords

    Search

    Navigation