Undiagnosed IgA Nephropathy as a Cause of End Stage Renal Disease Revealed after Early Recurrence in a Kidney Graft

An 18 year-old male was started on chronic hemodialysis due to glomerulonephritis. Despite any previous clinical symptom related to glomerular involvement, and foamy urines were assumed as normal. In a routine medical examination, he was found to be anemic. Advanced kidney failure was diagnosed and heavy proteinuria and micro hematuria were reported. A kidney biopsy revealed global glomerulosclerosis with copious non-specific inmunoglobulina mesangial deposition. Six months there after he received a kidney graft from his mother. Due to an increase in serum creatinine without hematuria and mild proteinuria 7 days after transplantation, a kidney graft biopsy revealed acute tubular necrosis and normal glomeruli. Kidney function improved. Three months after transplantation, when immunosuppression consisted on maintenance lowdose meprednisone, mycophenolate and tacrolimus, creatinine levels creped together with proteinuria and dysmorphic hematuria. A second kidney biopsy revealed IgA nephropathy, which was interpreted as the possible primary undiagnosed cause of end-stage kidney disease.