Tadokoro Akira, Tasaki Masayuki, Saito Kazuhide, Nakagawa Yuki, Ikeda Masahiro, Ishikawa Shoko, Imai Naofumi, Ito Yumi, Aizawa Naotaka, Baba Hironori, Takahashi Nao, Horii Arata, Takahashi Kota, Tomita Yoshihiko
Department of Urology, Molecular Oncology, Graduate School of Medical and Dental Sciences, Niigata University.
Division of Clinical Nephrology and Rheumatology, Department of Internal Medicine, Graduate School of Medical and Dental Sciences, Niigata University.
Nihon Hinyokika Gakkai Zasshi. 2019;110(2):92-99. doi: 10.5980/jpnjurol.110.92.
(Background) The standard treatment for recurrent immunoglobulin A nephropathy (rIgAN) after kidney transplantation (KTx) has not been established. (Methods) The results of treatment consisting of tonsillectomy and steroid pulse therapy in 20 recipients who were diagnosed as rIgAN were retrospectively analyzed. (Results) The level of proteinuria significantly decreased from 0.84±0.81 g/day to 0.27±0.31 g/day after treatment (P=0.007). Microscopic hematuria disappeared or improved in 58.3% and 66.6% of recipients 6 and 12 months after treatment, respectively. Serum creatinine levels remained stable for 5 years by the treatment, except for 3 cases of graft loss. Sixteen recipients received renal graft biopsies before and after treatment. Mesangial IgA deposition were dramatically decreased in 7 recipients (43.75%). The degree of mesangial hypercellularity, endocapillary hypercellularity, and crescents formation improved in 3 (18.8%), 6 (37.5%), and 4 (25%) recipients after treatment. (Conclusion) Steroid pulse therapy combined with tonsillectomy may be clinically and histopathologically effective treatment for rIgAN after KTx.
（背景）肾移植（KTx）后复发性免疫球蛋白A肾病（rIgAN）的标准治疗方法尚未确立。（方法）回顾性分析了20例被诊断为rIgAN的受者接受扁桃体切除术和类固醇冲击治疗的治疗结果。（结果）治疗后蛋白尿水平从0.84±0.81克/天显著降至0.27±0.31克/天（P = 0.007）。治疗后6个月和12个月，分别有58.3%和66.6%的受者镜下血尿消失或改善。除3例移植肾丢失外，通过该治疗血清肌酐水平在5年内保持稳定。16例受者在治疗前后接受了肾移植活检。7例受者（43.75%）的系膜IgA沉积显著减少。治疗后，3例（18.8%）、6例（37.5%）和4例（25%）受者的系膜细胞增多、毛细血管内细胞增多和新月体形成程度有所改善。（结论）类固醇冲击治疗联合扁桃体切除术可能是KTx后rIgAN临床和组织病理学上有效的治疗方法。
