Korean J Transplant.  2023 Nov;37(Suppl 1):S158. 10.4285/ATW2023.F-7447.

A case of crescentic immunoglobulin A nephropathy associated with Henoch-Schonlein purpura after kidney transplantation

• Kim NS
• Kim JK
• Oh JS

• KMID: 2551778
• DOI: http://doi.org/10.4285/ATW2023.F-7447

Abstract

Crescentic glomerulonephritis (GN) is a glomerular disease in which renal function deteriorates rapidly within days to months, and without appropriate treatment, it can progress to end-stage renal disease (ESRD). Henoch-Schonlein purpura is a systemic small vessel vasculitis in which immunoglobulin A (IgA) dominant immune complexes are mainly deposited. Histological findings in renal involvement are generally the same as those of IgA nephropathy, but progression to crescentic GN is very rare. We report a case of successful treatment of crescentic IgA nephropathy in a kidney transplant patient. The authors performed a kidney biopsy in a hospitalized renal transplant patient when the patient newly developed proteinuria during treatment of Henoch-Schonlein purpura. After biopsy, crescentic GN was confirmed, and the patient was treated with steroids. A 59-year-old female ESRD patient was hospitalized with abdominal pain, diarrhea, and bilateral extremity purpura 4 years after receiving a deceased donor kidney transplant at our hospital. During hospitalization, a transplanted kidney biopsy was performed for newly developed proteinuria, and the result confirmed Crescentic IgA nephropathy (IF: moderate megangial IgA deposits, LM: total glomeruli (9), global sclerosis (1), crescent (7). At the time, urine protein (+++), urine protein-creatinine ratio (uPCR) 3.55 mg/mgCr, BUN/Cr 18.2/0.74 mg/dL, and after steroid treatment (methyl-prednisolone 500 mg/day for 3 days), abdominal pain, diarrhea, bilateral purpura, and diarrhea all improved, and the patient was discharged. Immunosuppressive agents such as tacrolimus and mycophenolate mofetil were maintained at the same dose, and steroids were gradually reduced to 7.5 mg/day after steroids therapy. After 5 months, transplanted kidney biopsy was performed, and the biopsy confirmed Henoch-Schonlein purpura nephritis. Interstitial fibrosis and tubular atrophy (grade I) (Banff Score: ci1, ct1, as1) was confirmed, and urine protein (–), uPCR 0.24 mg/mgCr, and BUN/Cr 38.6/1.09 mg/dL are under observation.