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Recurrent IgA Nephropathy in Female Renal Transplant Patient

60-year-old female post renal transplant in 1998 presents with increasing proteinuria and hematuria. Renal biopsy suggests recurrent or de novo IgA nephropathy with no evidence of rejection. Comprehensive workup conducted including urine cytology, cystoscopy, and immunofluorescence studies.

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Recurrent IgA Nephropathy in Female Renal Transplant Patient

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  1. U07-1891 #617894700 • 60 y.o. female with s/p renal transplant 1998 • Increasing proteinuria

  2. 60 yrs old female • S/P DD renal Tx 29 March 1998 • ESRD secondary to GN • HTN • Dyslipidemia • Base line Cr 76 • Medications: • Cellcept, prednisone, Tacrolimus • Avapro

  3. Presented with increasing proteinuria and hematuria • Pr /Cr 108 May 2006 • Pr/Cr 253 Nov 2006 • Work up: • Urine cytology normal • Cystoscopy normal • SPEP and UPEP normal

  4. IF • IgG-Negative. • IgA- Moderate mesangial staining. • IgM- Mild vascular staining. • C3- Mild punctate mesangial staining. Mild vascular staining. • C1q-Negative. • Kappa-Negative. • Lambda- Moderate mesangial staining. • Fibrinogen- Mild interstitial staining. Mild mesangial staining. • Albumin-Negative. • C4d- Negative.

  5. IgA

  6. IgM

  7. C3

  8. C3

  9. Lambda

  10. Fibrin

  11. Fibrin

  12. EM • pending

  13. DiagnosisRenal Biopsy: • Biopsy of marginal adequacy (only 4 glomeruli and no arteries) showing changes consistent with recurrent or de novo IgA nephropathy. • There is no definitive evidence of rejection • Banff scores: • G0 CG0 I0 CI1 T0 CT1 V- CV- AH2 MM0

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