Division of Nephrology and Hypertension, Department of Internal Medicine, The Jikei University School of Medicine, Tokyo, Japan,
Division of Nephrology and Hypertension, Department of Internal Medicine, The Jikei University School of Medicine, Tokyo, Japan.
Nephron. 2023;147 Suppl 1:9-13. doi: 10.1159/000530341. Epub 2023 Mar 24.
IgA nephropathy (IgAN) is the most common form of glomerulonephritis worldwide. IgAN progresses to end-stage kidney disease in 20-40% of patients within 20 years of diagnosis. Kidney transplantation is the most effective option for patients with end-stage kidney disease caused by IgAN, but recurrence can occur in the transplanted kidney. The IgAN recurrence rate varies from 1% to 10% per year and varies according to the follow-up period, diagnostic modality, and biopsy criteria. Of note, studies based on protocol biopsies have reported a higher incidence of recurrence, which also occurred earlier after transplantation. In addition, recent data show that recurrence of IgAN is a more significant cause of allograft failure than previously believed. Little is known about the pathophysiology of IgAN recurrence, but several potential biomarkers have been investigated. Among them, galactose-deficient IgA1 (Gd-IgA1), IgG anti-Gd-IgA1 antibodies, and soluble CD89 could play a pivotal role in disease activity. This review aims to describe the current status of recurrent IgAN, including the incidence, clinical characteristics, risk factors, and future perspectives, with a focus on the available therapeutic approaches.
IgA 肾病（IgAN）是全球最常见的肾小球肾炎类型。在诊断后的 20 年内，20-40%的患者会进展为终末期肾病。对于由 IgAN 引起的终末期肾病患者，肾移植是最有效的选择，但移植肾可能会发生复发。IgAN 的复发率为每年 1-10%，且根据随访时间、诊断方式和活检标准而有所不同。值得注意的是，基于方案活检的研究报告复发率更高，且移植后更早发生。此外，最近的数据表明，IgAN 的复发是同种异体移植物失功的一个比之前认为更为重要的原因。对于 IgAN 复发的病理生理学知之甚少，但已经研究了几种潜在的生物标志物。其中，半乳糖缺乏 IgA1（Gd-IgA1）、IgG 抗 Gd-IgA1 抗体和可溶性 CD89 可能在疾病活动中发挥关键作用。本综述旨在描述复发性 IgAN 的现状，包括发病率、临床特征、危险因素和未来展望，重点介绍现有的治疗方法。
