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Abstract: PO2547

A Case of Subretinal IgA Deposition in a Patient with IgA Nephropathy and Early Allograft Recurrence

Session Information

Category: Trainee Case Report

  • 1901 Transplantation: Basic

Authors

  • Khan, Mahnoor Mahmud, Mayo Clinic's Campus in Florida, Jacksonville, Florida, United States
  • Baker, Lyle Wesley, Mayo Clinic's Campus in Florida, Jacksonville, Florida, United States
  • Suliman, Sarah T., Mayo Clinic's Campus in Florida, Jacksonville, Florida, United States
  • Mai, Martin L., Mayo Clinic's Campus in Florida, Jacksonville, Florida, United States
Introduction

IgA Nephropathy (IgAN) has variable clinical manifestations and a 30% recurrence, which is typically a late complication in renal transplant recipients. Ocular involvement in patients with IgAN is extremely rare. Thus, eye findings as a predictor of worse prognosis, including higher risk of recurrence, remains unexplored.

Case Description

A 66 year old Caucasian male with end-stage renal disease secondary to a 10 year history of IgAN complicated by retinal detachment and optic neuropathy with recent decline in visual acuity, underwent living related donor renal transplantation from his twin sister with Basiliximab induction. A month prior, Optical Coherence Tomography (OCT) had revealed bilateral macular edema and subretinal pigment deposits with central foveal sparing, consistent with IgA maculopathy. Post-operative course was uneventful with immediate allograft function and normalization of creatinine. 4 months later, repeat OCT showed improved retinopathy and ocular edema. However, renal function declined 2 months later, with persistently elevated Creatinine between 1.4-1.5 mg/dL. Allograft biopsy showed hypercellular endocapillary proliferation, glomerulitis and granular mesangial staining for IgA, IgM, Kappa and Lambda on Immunofluorescence, consistent with recurrent IgAN. Pulse-dose steroids were subsequently initiated.

Discussion

The pivotal role of the complement system has been implicated in IgA deposition between the retinal pigment epithelium (RPE) and Bruch’s membrane, a complex exposed to circulating immune complexes similar to glomerular basement membrane. To our knowledge, this is the first reported case of IgA maculopathy involving subretinal deposition with recurrence of primary disease in the renal allograft within 1 year. Given the lack of non-invasive testing and dynamic clinical features encompassed by IgAN, the link between ocular pathology and patient-specific morbidity including recurrence, despite clinical improvement in initial eye disease, needs exploration.