Journal
AMERICAN JOURNAL OF TRANSPLANTATION
Volume 23, Issue 10, Pages 1626-1630Publisher
ELSEVIER SCIENCE INC
DOI: 10.1016/j.ajt.2023.05.031
Keywords
IgA nephropathy; complement; glomerulonephritis; recurrence; transplantation
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Crescentic forms of IgA nephropathy are rare but can lead to rapid kidney failure. Complement inhibitors may be a rational treatment option for patients unresponsive to immunosuppressive therapy. We report a successful case of crescentic IgA nephropathy recurrence after kidney transplantation, in which eculizumab was used as a rescue therapy.
Crescentic forms of immunoglobulin A nephropathy (IgAN) are rare but can be associated with rapid kidney failure and a high rate of end-stage renal disease despite immunosuppression therapy. Complement activation has emerged as a key driver of glomerular injury in IgAN. Therefore, complement inhibitors may be a rational treatment option in patients unresponsive to first-line immunosuppressive therapy. Here, we describe the case of a 24year-old woman presenting with crescentic IgAN recurrence a few months after living kidney transplantation. Considering the dramatic graft failure accompanied by malignant hypertension and thrombotic microangiopathy features worsening after a first-line of highdose steroids and 3 sessions of plasma exchanges, eculizumab was started as a rescue therapy. For the first time, the clinical response to eculizumab was highly successful, with a complete graft recovery without any relapse after 1 year of treatment. Further clinical studies are strongly needed to specify which patients might benefit from terminal complement blockade.
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