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

BMC Nephrology

Hiroki Yamada¹  Jun Miki¹  Hiroyasu Yamamoto²  Mayuko Kawabe³  Yusuke Okabayashi³  Izumi Yamamoto³  Yasuyuki Nakada³  Haruki Katsumata³  Yudo Tanno³  Takafumi Yamakawa³  Nobuo Tsuboi³  Takashi Yokoo³  Akimitsu Kobayashi³  Ai Katsuma³  Ichiro Ohkido³  Yo Komatsuzaki³ 

[1] Department of Urology, The Jikei University School of Medicine;Department of internal Medicine, Atsugi City Hospital;Division of Nephrology and Hypertension, Department of Internal Medicine, The Jikei University School of Medicine;

关键词: IgA nephropathy;    Kidney transplantation;    Tonsillectomy;    Steroid;    Calcineurin inhibitor nephrotoxicity;    Case report;   

DOI  :  10.1186/s12882-018-0858-9

来源: DOAJ

【 摘 要 】

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.

【 授权许可】

Unknown