Author: Leo
Keywords: renal transplantation | IgA nephropathy
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| From goolgle images |
(1) how to accurately diagnose the recurrence of IgAN after renal transplantation
Large sample studies have shown that renal transplantation after glomerular disease recurrence of renal allograft loss accounted for the third, second only to chronic rejection and death of the recipient. Recently, many studies have focused on the problem of IgAN recurrence after renal transplantation. The recurrence rate of IgAN is 24% ~ 61%, and the loss rate of transplanted kidney is 5% ~ 23% due to recurrence of IgAN. This study was found during renal transplant follow-up. Patients with primary IgAN had a 31% (46/148) recurrence of IgAN after routine renal biopsy with renal biopsy. The rate of graft loss was 22% due to IgAN recurrence (10/46 ). Strictly speaking, the diagnosis of recurrent IgAN need to have two basic elements: First, autologous kidney before transplantation with primary IgAN characteristics, and second, in the transplanted kidney and then the same pathological type. The above two basic elements in clinical practice is often difficult to have at the same time. The vast majority of patients have been admitted to the ESRD, the lack of primary pathogenesis of histopathological diagnosis; Second, some patients after transplantation only showed mild proteinuria or microscopic hematuria, often refused to accept renal biopsy, so it is It is difficult to make an accurate judgment. Therefore, the current recurrence of IgAN after renal transplantation reported different reports.
In this study, we collected the results of renal biopsy at the time of renal transplantation and at multiple time points. It was found that the time of IgAN recurrence in renal transplant recipients was 9.3 ± 3.6 months after operation. I believe that do a good job of autologous kidney, kidney and kidney transplant kidney biopsy is the key to early diagnosis of recurrent IgAN.
(2) What are the clinical features of IgAN recurrence after renal transplantation?
Autologous kidney IgAN recurrence of patients with asymptomatic microscopic hematuria, proteinuria and renal function was a progressive decline in characteristics, then the transplant kidney IgAN recurrence of what characteristics?
Our results suggest that U-RBC counts and 24-hour urinary protein quantification increase gradually in IgAN recurrence after renal transplantation, especially at 2, 3, and 5 years after renal transplantation, U-RBC counts and 24h Urine protein was significantly higher than non-IgAN recurrence. Similarly, the Scr of the IgAN recurrence group gradually increased, while the GFR gradually decreased. It can be seen that the U-RBC count, the increase of urinary protein and the progressive decline of renal function after renal transplantation are the main clinical features of IgAN recurrence after renal transplantation.
(3) What are the pathological features of IgAN recurrence after renal transplantation?
In primary IgAN, many of the previous clinical studies have reported glomerular mesangial proliferation, severe sclerosing changes such as focal segmental or sclerosis, renal interstitial fibrosis and tubular atrophy and IgAN prognosis related. At present, there are few reports about the clinicopathological features of IgAN recurrence after renal transplantation and the clinical processes associated with transplantation.
Our study showed that the incidence of tissue damage in crescent formation, glomerular wall adhesions, mesangial cell proliferation, mesangial area enlargement, focal segmental and sclerotic sclerosis were significantly higher in IgAN recurrence group than in non- IgAN recurrence group. Some scholars suggest that IgAN recurrence or transplantation after IgAN patients, glomerular crescent formation and prognosis is poor. The incidence of renal disinfection and renal interstitial fibrosis in IgAN recurrence group was significantly higher than that in non-IgAN recurrence group, which indicated that the recurrence of renal allograft and renal interstitial fibrosis were the main reasons for the loss of renal allograft one.
IgAN recurrence is a risk factor for promoting glomerulosclerosis. The chronic injury index of IgAN recurrence group and non-IgAN relapse group were 7.7 ± 2.3 and 4.6 ± 1.4 (P <0.01), suggesting that chronic injury in IgAN recurrence group was significant, and it was pointed out that the chronic injury of transplanted kidney entered the process of ESRD after renal transplantation Plays an important role. This study shows that the incidence of chronic rejection and C4d deposition in IgAN recurrence group was significantly higher than that in non-IgAN recurrence group. It has been reported that chronic rejection and C4d deposition are one of the important factors to predict recurrence of IgAN.
(4) how does the prognosis of recurrence of IgAN after renal transplantation?
We found that long-term survival in non-IgAN recurrence was significantly higher than that in IgAN recurrence. Although the survival rate of transplanted kidney was not statistically significant at 1 year and 3 years after renal transplantation, the survival rate of renal transplant recipients was significantly lower than that of non-IgAN recurrence group at 5 years after renal transplantation. It can be seen that recurrent IgAN after renal transplantation is still lack of radical means, even if the use of existing immunosuppressive agents after transplantation failed to terminate the development of IgAN.
In conclusion, the recurrence of IgA nephropathy after renal transplantation is characterized by progressive descending hematuria, proteinuria and renal function, which will reduce the long-term survival rate of transplanted kidney, suggesting poor prognosis.
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