Treatment of Recurrent IgA Nephropathy after Kidney Transplant with Delayed-Release Budesonide

Introduction: IgA nephropathy (IgAN), the most prevalent form of glomerulonephritis worldwide, is characterized by hematuria, proteinuria, and progressive kidney function decline. Currently, there are no clear guidelines on the treatment of recurrent IgAN post-transplant. Case Description: A 22-year-old Caucasian male with a history of end-stage kidney disease secondary to IgAN status post-kidney transplant two years ago on maintenance therapy with tacrolimus, mycophenolate mofetil, and low-dose steroids presented with hematuria, proteinuria, and declining kidney function. A follow-up biopsy on the transplanted kidney revealed recurrent IgAN with secondary focal and segmental glomerulosclerosis but without signs of acute rejection (Figure 1). Delayed release (DR) budesonide was initiated, and he tolerated the medication well. Figure 2 shows his eGFR and UPCR improvement three months after starting the treatment. Discussion: The FDA has approved DR budesonide for managing adults with primary IgAN at risk of rapid disease progression. However, transplant patients were excluded from the NefIgArd trial. Our case report suggests future studies on the effects of DR budesonide for treating recurrent IgAN post-transplant.Figure 1. Kidney biopsy revealed recurrent IgANFigure 2. eGFR and UPCR Trend