Possible Consequences of Non-Adherence to Immunosuppression: a Case of Acute T-Cell Mediated Kidney Rejection and IgA Nephropathy

Patients with primary immunoglobulin A nephropathy (IgAN) usually represent ideal candidates for a renal transplantation. IgA nephropathy represents the most frequent form of recurrent glomerulonephritis post kidney transplant. The therapeutic effects of post transplant immunosuppressive therapy seem to be related to the ability to regulate T-cell immunity and the Th1/Th2 balance. T-cell dysregulation plays an important role in IgAN pathogenesis and recurrence post kidney transplantation. We describe the case of a 52 years old Asian woman with IgAN who received an unrelated living donor kidney transplant. She had independently withdrawn all immunosuppressive maintenance therapy seven years after transplantation followed by acute kidney dysfunction. Acute T-cell mediated rejection was demonstrated in the first kidney biopsy. High steroid pulses were administered with partial response. Recurrence of native IgAN associated with partial resolution of T-cell mediated rejection was observed, as showed in the second kidney biopsy. We hypothesize that recurrence of primary nephropathy could be a manifestation of T-cells activation in non-adherent patients partially responsive to T-cell anti-rejection therapy.