Author: Leo
Keywords: renal transplantation ， IgA nephropathy
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| From google images |
IgA nephropathy (IgA) is the most common primary glomerular disease in the world. Its incidence is 39.9% of primary glomerulonephritis, of which about 1/3 patients progress to 10 to 20 years End stage renal disease (ESRD). Kidney transplantation is the most effective alternative to renal therapy in patients with ESRD. The recurrence of primary glomerulonephritis, especially renal transplantation, is associated with the survival rate of transplanted kidneys. IgAN recurrence rate of up to 60% after transplantation, for a considerable number of patients, renal transplantation after IgAN recurrence will lead to accelerated graft death rate, nearly 13% of patients with IgAN recurrence of renal failure, about 5% Renal loss due to recurrence.
The aim of this study was to determine the recurrence rate of IgAN after renal transplantation by routine renal biopsy (biopsy) and to explore the clinicopathological features and prognosis of IgAN recurrence after renal transplantation.
Second, the research object and grouping
A total of 148 patients with endogenous renal failure who underwent renal transplantation from January 1996 to April 2009 were selected as the subjects of the National Renal Disease Clinical Medicine Research Center in Nanjing General Hospital of Nanjing Military Region. All patients were diagnosed with IgAN or IgAN recurrence by renal biopsy. Forty-six patients were diagnosed with IgAN recurrence after renal transplantation. The recurrence time was 9.3 ± 3.6 months.
According to renal transplantation after IgAN recurrence, divided into IgAN recurrence group (46 cases) and non-IgAN recurrence group (102 cases). All recipients received tacrolimus (FK506) + mycophenolate mofetil (MMF) + adrenocorticotropic hormone (Hormone) triple immunosuppressive regimen.
Third, the results
Urinary sediment erythrocyte count and 24 h urinary protein quantification
(1) Comparison of the two groups of recipients after renal transplantation
(U-RBC) and 24h urinary protein were gradually increased after renal transplantation, but the change of the two indexes in the non-IgAN recurrence group was more stable than that of the non-IgAN recurrence group. There was no significant difference in U-RBC count and 24 h urinary protein between the two groups at the time of renal transplantation and 1 year after operation (all P> 0.05). However, the U-RBC count of IgAN recurrence group was significantly increased and the urinary protein was also significantly increased (P <0.01 ~ 0.001) compared with non-IgAN recurrence group at 2, 3 and 5 years after operation.
Transplantation of renal function
(2) Comparison of two groups of recipients after renal transplantation
The level of serum creatinine (Scr) gradually increased after renal transplantation in IgAN recurrence group, but the level of Scr after IgAN recurrence group was more stable. There were no significant differences in Scr levels between the two groups (P> 0.05). However, compared with the non-IgAN recurrence group, Scr of the IgAN recurrence group was significantly higher than that in the non-IgAN recurrence group (P <0.001).
The glomerular filtration rate (GFR) of renal recurrence group was gradually decreased after renal transplantation, but GFR was gradually increased after IgAN recurrence group. There was no significant difference between the two groups (P> 0.05). However, compared with the non-IgAN recurrence group, the GFR of the IgAN recurrence group was significantly lower than that of the control group (P <0.05) P <0.001).
Transplantation of renal pathology
(3) two groups of recipients after renal transplantation changes
Transplantation renal biopsy found that IgAN recurrence of cell crescent formation, glomerular adhesion, mesangial cell proliferation, mesangial matrix increased, sclerosis, glomerular segmental sclerosis, globular waste and renal interstitial fibrosis And the incidence was significantly higher than non-IgAN recurrence group (all P <0.001). IgAN recurrence group and non-IgAN recurrence group were 7.7 ± 2.3 and 4.6 ± 1.4 (P <0.01), respectively. The incidence of acute rejection was 11% (P> 0.05), the incidence of chronic rejection was 17% and 6% (P <0.001), and the incidence of renal nephropathy was not found in IgAN recurrence group and non-IgAN recurrence group Including the incidence of IgAN) were 7% and 2% (P <0.01), the incidence of C4d deposition was 24% and 15% (P <0.01), the incidence of FK506 nephrotoxicity was 9% and 9% (P Gt; 0.05).
Graft survival rate
(4) changes in the two groups of recipients after renal transplantation
IgU recurrence group and non-IgAN recurrence group were 93.8% and 95.6%, 86.7% and 88.3% respectively (P> 0.05) at 1 year and 3 years after transplantation, and 51.4% And 83.8% (P <0.001). IgN recurrence group in 10 patients (22%) and non-IgAN recurrence group 9 patients (9%) patients with renal failure.
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