Immunoglobulin a nephropathy and renal transplantation

Abstract

In this review, we discuss the incidence of immunoglobulin A (IgA) mesangial deposits and IgA mesangial nephritis recurring in renal transplants in those patients whose renal failure was caused by IgA nephropathy (IgAN) or Henoch-Schönlein purpura. The variable rate of recurrence is discussed in the context of its clinical manifestations of microscopic haematuria and, in progressive disease, proteinuria and hypertension, and compared with the natural history of primary IgAN. Modern theories of pathogenesis of the native disease, including the roles of defective mucosal immunity and deposition in the mesangium of abnormally glycosylated IgA1 molecules are described. Whether variations in the extents to which the described abnormalities in mucosal immunity play a part in determining the natural history of primary and recurrent IgA nephropathy is debated. On the basis of evidence presented, recommendations are made regarding transplantation in patients with IgA nephropathy. The predictability rate and risks of recurrence are also discussed, together with therapeutic options. Copyright © 1999 by W.B. Saunders Company.