Prognostic factors for renal allograft survival in patients with immunoglobulin A nephropathy: A case control study

Guo,Jun-Qi; Song,Bao-Lin; Wu,Zhi-Xian; Wu,Wei-Zhen; Luo,Liu-Tao; Chen,Xiao-Wen; He,Fu-Qiang; Zheng,Zhi-Yong; Yang,Shun-Liang; Tan,Jian-Ming

doi:10.3892/mmr.2014.1954

Prognostic factors for renal allograft survival in patients with immunoglobulin A nephropathy: A case control study

Authors:
- Jun-Qi Guo
- Bao-Lin Song
- Zhi-Xian Wu
- Wei-Zhen Wu
- Liu-Tao Luo
- Xiao-Wen Chen
- Fu-Qiang He
- Zhi-Yong Zheng
- Shun-Liang Yang
- Jian-Ming Tan
View Affiliations

Affiliations: Organ Transplant Institute, Fuzhou General Hospital, Fujian Medical University and Fujian Key Laboratory of Transplant Biology, Fuzhou, Fujian 350025, P.R. China, Department of Urology, Jiaxing Traditional Chinese Medical Hospital, Jiaxing, Zhejiang 314000, P.R. China
Published online on: February 17, 2014 https://doi.org/10.3892/mmr.2014.1954
Pages: 1179-1184

Metrics: Total Views: 0 (Spandidos Publications: | PMC Statistics: )

Metrics: Total PDF Downloads: 0 (Spandidos Publications: | PMC Statistics: )

Cited By (CrossRef): 0 citations Loading Articles...

Abstract

The renal allograft survival rates of patients with immunoglobulin A nephropathy (IgAN), and patients with or without other glomerular diseases, have yet to be fully elucidated. In this study, the clinicopathological factors associated with long-term allograft survival for the prognosis of renal allograft recipients with IgAN were examined. All patients enrolled in this study were diagnosed with IgAN following clinical and pathological examinations. Patients underwent renal graft biopsy and were hospitalized at the Fuzhou General Hospital between June, 2004 and December, 2010. Common demographic and clinical indicators were recorded in patients who had graft loss and in those who had functional renal grafts. Forty-two of the 202 biopsy specimens (20.8%) met the diagnostic criteria for IgAN and were divided into two groups, the graft loss group (n=17) and the functional graft group (n=25). Patients were followed up for 1-257 months after kidney transplantation. The mean patient age was 40.6±9.3 years at the time of renal graft biopsy. Examination results indicated concomitant proteinuria and hematuria in 25 patients (59.5%) and proteinuria alone in six patients (14.3%). Graft loss occurred in 17 patients during the follow-up period. Comparison of the graft loss and the functional graft groups indicated that patients in the graft loss group were more likely to have proteinuria (P=0.047), high creatinine levels at the time of biopsy (P=0.009), low glomerular filtration rates (P=0.013), low serum total protein (P=0.01), a high Banff score (P=0.001), extensive glomerulosclerosis (P=0.002), a greater likelihood of crescent formation (P=0.01), severe tubular atrophy (P=0.013) and more extensive interstitial fibrosis (P=0.033). However, the two groups showed no significant differences in blood pressure, hematuria, BUN, UA, Hb, TG and CHO levels. The allograft survival rate of patients with IgAN was identified to be similar to that of patients with and without other glomerular diseases.

View Figures

View References

1	Bi ZQ: Clinical and pathological analysis of 40 cases of IgA nephropathy. Zhonghua Nei Ke Za Zhi. 23:136–140. 1984.(In Chinese).
2	Li LS: Clinicopathological correlation of 34 cases of IgA nephropathy. Zhonghua Nei Ke Za Zhi. 23:336–339. 3971984.(In Chinese).
3	Berger J, Yaneva H, Nabarra B and Barbanel C: Recurrence of mesangial deposition of IgA after renal transplantation. Kidney Int. 7:232–241. 1975. View Article : Google Scholar : PubMed/NCBI
4	Odum J, Peh CA, Clarkson AR, et al: Recurrent mesangial IgA nephritis following renal transplantation. Nephrol Dial Transplant. 9:309–312. 1994.PubMed/NCBI
5	Kessler M, Hiesse C, Hestin D, et al: Recurrence of immunoglobulin A nephropathy after renal transplantation in the cyclosporin era. Am J Kidney Dis. 28:99–104. 1996. View Article : Google Scholar : PubMed/NCBI
6	Ohmacht C, Kliem V, Burg M, et al: Recurrent immunoglobulin A nephropathy after renal transplantation: a significant contributor to graft loss. Transplantation. 64:1493–1496. 1997. View Article : Google Scholar : PubMed/NCBI
7	Mafsugami K, Naito T, Nitta K, et al: A clinicopathological study of recurrent IgA nephropathy following renal transplantation. Nippon Jinzo Gakkai Shi. 40:322–328. 1998.(In Japanese).
8	Berthoux B, Diconne E, Mariat C, et al: Risk factors for primary IgA nephropathy recurrence after renal transplantation (RTx). Nephrol Dial Transplant. 18:801–802. 2003.
9	Namba Y, Oka K, Moriyama T, et al: Risk factors for graft loss in patients with recurrent IgA nephropathy after renal transplantation. Transplant Proc. 36:1314–1316. 2004. View Article : Google Scholar : PubMed/NCBI
10	Couser W: Recurrent glomerulonephritis in the renal allograft: an update of selected areas. Exp Clin Transplant. 3:283–288. 2005.PubMed/NCBI
11	Ng YS, Vathsala A, Chew ST, et al: Long term outcome of renal allografts in patients with immunoglobulin A nephropathy. Med J Malaysia. 62:109–113. 2007.PubMed/NCBI
12	Moriyama T, Nitta K, Suzuki K, et al: Latent IgA deposition from donor kidney is the major risk factor for recurrent IgA nephropathy in renal transplantation. Clin Transplant. 19:41–48. 2005. View Article : Google Scholar : PubMed/NCBI
13	Kiattisunthorn K, Premasathian N, Wongwiwatana A, et al: Evaluating the clinical course and prognostic factors of posttransplantation immunoglobulin A nephropathy. Transplant Proc. 40:2349–2354. 2008. View Article : Google Scholar : PubMed/NCBI
14	Racusen LC, Solez K, Colvin RB, et al: The Banff 97 working classification of renal allograft pathology. Kidney Int. 55:713–723. 1999. View Article : Google Scholar : PubMed/NCBI
15	Briganti EM, Russ GR, McNeil JJ, et al: Risk of renal allograft loss from recurrent glomerulonephritis. N Engl J Med. 347:103–109. 2002. View Article : Google Scholar : PubMed/NCBI
16	Sanfilippo F, Croker BP and Bollinger RR: Fate of four cadaveric donor renal allografts with mesangial IgA deposits. Transplantation. 33:370–376. 1982. View Article : Google Scholar : PubMed/NCBI
17	Ji S, Liu M, Chen J, et al: The fate of glomerular mesangial IgA deposition in the donated kidney after allograft transplantation. Clin Transplant. 18:536–540. 2004. View Article : Google Scholar : PubMed/NCBI
18	Berger J: Recurrence of IgA nephropathy in renal allografts. Am J Kidney Dis. 12:371–372. 1988. View Article : Google Scholar : PubMed/NCBI
19	Wang AY, Lai FM, Yu AW, et al: Recurrent IgA nephropathy in renal transplant allografts. Am J Kidney Dis. 38:588–596. 2001. View Article : Google Scholar : PubMed/NCBI
20	McDonald SP and Russ GR: Recurrence of IgA nephropathy among renal allograft recipients from living donors is greater among those with zero HLA mismatches. Transplantation. 82:759–762. 2006. View Article : Google Scholar : PubMed/NCBI
21	Soler MJ, Mir M, Rodriguez E, et al: Recurrence of IgA nephropathy and Henoch-Schönlein purpura after kidney transplantation: risk factors and graft survival. Transplant Proc. 37:3705–3709. 2005.
22	Andresdottir MB, Haasnoot GW, Doxiadis II, et al: Exclusive characteristics of graft survival and risk factors in recipients with immunoglobulin A nephropathy: a retrospective analysis of registry data. Transplantation. 80:1012–1018. 2005. View Article : Google Scholar : PubMed/NCBI
23	Andresdottir MB, Haasnoot GW, Persijn GG and Claas FH: HLA-B8, DR3: a new risk factor for graft failure after renal transplantation in patients with underlying immunoglobulin A nephropathy. Clin Transplant. 23:660–665. 2009. View Article : Google Scholar : PubMed/NCBI
24	Tang Z, Ji SM, Chen DR, et al: Recurrent or de novo IgA nephropathy with crescent formation after renal transplantation. Ren Fail. 30:611–616. 2008. View Article : Google Scholar : PubMed/NCBI
25	Kowalewska J, Yuan S, Sustento-Reodica N, et al: IgA nephropathy with crescents in kidney transplant recipients. Am J Kidney Dis. 45:167–175. 2005. View Article : Google Scholar : PubMed/NCBI
26	Oka K, Imai E, Moriyama T, et al: A clinicopathological study of IgA nephropathy in renal transplant recipients: beneficial effect of angiotensin-converting enzyme inhibitor. Nephrol Dial Transplant. 15:689–695. 2000. View Article : Google Scholar