UNUSUAL CORRELATION OF LATE IGA-NEPHROPATHY RECURRENCE AND RENAL PAPILLARY CARCINOMA DEVELOPED IN A KIDNEY TRANSPLANT RECIPIENT

A case of a 50-year-old Caucasian man transplanted in 1987 for an end-stage renal disease caused by an IgAN is reported. The graft was from a living donor. Immunosuppression regimen was based on cyclosporine, azathioprine and steroids. After 25 years of uneventful follow-up, the patient developed a generalized edema and was hospitalized. At blood tests, serum creatinine was 4 mg/dl and a marked proteinuria was reported (18 g/24 h). No renal masses were observed at ultrasounds. A renal biopsy was performed, showing granular deposits of IgA ( +++), IgM (++), C3 (+), kappa (+) and lambda(++) light chains in the mesangium: IgAN recurrence was diagnosed. Drug regimen was modified with the intent to treat both the IgAN recurrence and the proteinuria: however, the status of poor renal function persisted. Six months later, a new ultrasounds control was performed, showing three lesions at the level of the allograft. A CT scan confirmed the diagnosis. A renal biopsy showed of a papillary renal cell carcinoma type 1. The patient underwent the explantation of the allograft. The tumor was confirmed at pathology on the specimen. The post-operative course was uneventful, and the patient is still alive after a period of 6 months, having restarted the substitutive therapy with haemodyalisis. IgAN recurrence after transplant is common, while development of a tumor on the allograft is anecdotic: however no data exist in Literature about a contemporaneous presentation of both these pathologies.