Recurrent IgA nephropathy in transplant kidney
Three years post renal transplant. Presents with chills and haemautria ?stone ?obstruction.
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Right iliac fossa transplant kidney is swollen with surrounding fat stranding. No calculus is seen within the transplant kidney or ureter with a surgical at the transplant vesicoureteric anastomosis.
Renal transplant core biopsy:
- Mesangial IgA, C3 and C1q, focal mild mesangial proliferation and a segmental cellular crescent in 1/9 viable glomeruli consistent with recurrent IgA disease. There were no active crescents in the previous biopsy and no mesangial proliferation at that time but there were small amounts of mesangial IgA.
- Mild glomerulitis and mild peritubular capillaritis with C4d in glomerular capillaries consistent with antibody-mediated rejection. This was not present previously.
IgA nephropathy (Berger disease) is the most common cause of primary glomerulonephritis. It can lead to end stage renal failure, and is one of the most common indications for renal transplant. Recurrent IgA nephropathy in transplant kidneys occurs in up to 60% of patients histologically with up to 20% experiencing transplant dysfunction or failure.