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ADTKD-UMOD — ESENeph MCQ

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HardTubular DisordersADTKD-UMODESENeph

Two years after kidney transplantation, a recipient whose native disease was IgA nephropathy develops new haematuria and proteinuria. Allograft biopsy shows mesangial IgA-dominant deposits without evidence of rejection. What is the diagnosis?

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Correct answer: D — Recurrent IgA nephropathy affecting the kidney allograft

The best answer is “Recurrent IgA nephropathy affecting the kidney allograft”. The native diagnosis, new haematuria and proteinuria, and biopsy showing mesangial IgA-dominant deposits establish recurrent IgA nephropathy. Other transplant causes remain important differentials but have different histological and virological features. “Acute T-cell-mediated rejection” is less appropriate because the biopsy would show tubulitis and interstitial inflammation rather than isolated mesangial IgA-dominant deposits “BK-polyomavirus nephropathy” is less appropriate because viral cytopathic change and confirmatory viral testing, not mesangial IgA, define BK nephropathy “Calcineurin-inhibitor toxicity” is less appropriate because this causes arteriolar and chronic ischaemic lesions rather than recurrent mesangial immune deposits “De novo minimal-change disease” is less appropriate because minimal-change disease does not explain mesangial IgA-dominant deposits and haematuria

Reference: KDIGO kidney transplant recipient guideline: https://kdigo.org/wp-content/uploads/2022/09/KDIGO-2009-Transplant-Recipient-Guideline-English.pdf