Mousson C, Charon-Barra C, Funes de la Vega M, Tanter Y, Justrabo E, Martin L, Rifle G
Department of Nephrology-Intensive Care-Transplantation, University Hospital du Bocage, 2 Boulevard de Lattre de Tassigny, 21000 Dijon, France.
Transplant Proc. 2007 Oct;39(8):2595-6. doi: 10.1016/j.transproceed.2007.08.025.
Crescentic IgA nephropathy is an uncommon finding in native kidneys (3%-5%) and in renal transplants. This study was performed to determine the frequency of relapsing crescentic IgA nephropathy after kidney transplantation. Over a 15-year period, 42 patients (25 men, 17 women) of age range 17 to 59 years with biopsy-proven IgA nephropathy in their native kidneys were entered into this retrospective study, because they had undergone kidney transplantation and had sequential allograft biopsies during their follow-up. Mean follow-up after transplantation was 8.9 years (range, 1-15 years). In their native kidneys, 5 patients (12%) had more than 20% crescents, and only 2 (5%) had more than 50% of glomeruli involved. As expected, 52.4% of recipients showed recurrent mesangial IgA deposits in their kidney grafts. The 2 patients with diffuse crescentic IgA nephropathy in their native kidneys experienced acute graft dysfunction at 15 and 47 months. Graft biopsy showed recurrent IgA deposits with cellular crescents in 30% and 20% of glomeruli, respectively. Despite corticosteroid pulse therapy, graft failures occurred 2 and 27 months later. No crescentic proliferation was observed during follow-up in any other case. Only 5 other grafts failed because of chronic allograft nephropathy, without any relationship to the relapse of IgA deposits. These data suggested for the first time that only diffuse crescentic IgA nephropathy in the native kidneys was associated with the occurrence of crescents in the kidney transplants, a finding that raises the possibility of a particular subgroup of IgA nephropathies.
新月体性IgA肾病在原发性肾脏（3%-5%）及肾移植中均为少见表现。本研究旨在确定肾移植后复发性新月体性IgA肾病的发生率。在15年期间，42例年龄在17至59岁之间、经活检证实原发性肾脏患有IgA肾病的患者（25例男性，17例女性）纳入本回顾性研究，因为他们接受了肾移植且在随访期间进行了系列移植肾活检。移植后的平均随访时间为8.9年（范围1-15年）。在其原发性肾脏中，5例患者（12%）有超过20%的新月体，仅有2例（5%）超过50%的肾小球受累。正如预期，52.4%的受者在移植肾中出现复发性系膜IgA沉积。2例原发性肾脏为弥漫性新月体性IgA肾病的患者分别在15个月和47个月时出现急性移植肾功能障碍。移植肾活检显示，分别有30%和20%的肾小球出现复发性IgA沉积伴细胞性新月体。尽管进行了糖皮质激素冲击治疗，移植肾分别在2个月和27个月后出现功能丧失。在其他任何病例的随访中均未观察到新月体增生。仅有另外5个移植肾因慢性移植肾肾病而功能丧失，与IgA沉积复发无关。这些数据首次提示，仅原发性肾脏的弥漫性新月体性IgA肾病与移植肾中新月体的出现相关，这一发现提示了IgA肾病可能存在一个特殊亚组。
