Publication: Evaluating the Clinical Course and Prognostic Factors of Posttransplantation Immunoglobulin A Nephropathy
Issued Date
2008-09-01
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ISSN
00411345
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2-s2.0-51249106678
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Mahidol University
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SCOPUS
Bibliographic Citation
Transplantation Proceedings. Vol.40, No.7 (2008), 2349-2354
Suggested Citation
K. Kiattisunthorn, N. Premasathian, A. Wongwiwatana, P. Parichatikanond, B. Cheunsuchon, S. Vasuvattakul Evaluating the Clinical Course and Prognostic Factors of Posttransplantation Immunoglobulin A Nephropathy. Transplantation Proceedings. Vol.40, No.7 (2008), 2349-2354. doi:10.1016/j.transproceed.2008.07.008 Retrieved from: https://repository.li.mahidol.ac.th/handle/20.500.14594/19554
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Title
Evaluating the Clinical Course and Prognostic Factors of Posttransplantation Immunoglobulin A Nephropathy
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Abstract
Introduction: Previous reports have suggested that posttransplantation immunoglobulin (Ig) A nephropathy displays a relatively benign course, hardly ever affecting graft function. However, more recent studies with longer follow-up have shown that posttransplantation IgA nephropathy may be a significant contributor to graft loss. Additionally, there may be other clinical or pathological factors that affect long-term graft outcome. We retrospectively analyzed 30 kidney transplant recipients with biopsy-proven IgA nephropathy in their allografts to determine the clinical course and prognostic factors in posttransplantation IgA nephropathy. The median duration of follow-up was 36 months (range, 1 month-17 years). The median onset of IgA nephropathy was 33.6 months posttransplantation (range, 5 days-103 months). The most common presentation was an abnormal urine examination (96.6%). Fifteen (50%) displayed microscopic hematuria with proteinuria more than 1 g/d. Fifteen patients (50%) lost their grafts at a median time of 24 months after the onset of disease (range, 1-93 months). Allograft loss was associated with a high serum creatinine level at the time of diagnosis (3.68 ± 2.23 vs 1.79 ± 0.34 mg/dL; P = .006), a greater level of proteinuria at the time of diagnosis (2.43 ± 0.76 vs 1.29 ± 1.07 g/d; P = .003), and more than 50% extracapillary proliferation (P = .05). Fibrinoid necrosis on allograft pathology impacted 1-year allograft survival (P = .025). Conclusion: Posttransplantation IgA nephropathy worsens allograft outcomes among patients with increased serum creatinine level or significant proteinuria at presentation or significant glomerular inflammation and/or tubulointerstitial damage. © 2008 Elsevier Inc. All rights reserved.