Treatment of recurrent IgA nephropathy after kidney transplantation with targeted-release budesonide - a case report

Immunoglobulin A nephropathy (IgAN) is one of the most common forms of primary glomerulonephritis which can lead to kidney failure requiring kidney replacement therapy via dialysis or transplantation. Unfortunately, IgAN can recur within the allograft. For treatment of primary IgAN, a targeted-release formulation of budesonide that acts specifically within the ileum can be used to prevent disease progression. The use of targeted-release budesonide in the setting of recurrent IgAN after transplantation has not yet been studied in detail. We here report a 28-year-old female with IgAN recurrence after transplantation, treated by targeted release budesonide for 9 months. Prior to treatment initiation in April 2023, estimated glomerular filtration rate (eGFR) drastically decreased, reaching  24 ml/min/1.73 m² within 10 months. With treatment, the eGFR decrease slowed down considerably (- 6 ml/min/1.73 m² within 12 months). The urine protein-to-creatinine-ratio (UPCR) likewise decreased from 4.55 g/g creatinine before therapy start to 1.30 g/g 12 months after therapy start. Despite episodes of poorly controlled hypertension and edema during treatment that were related to interruption of medications, blood pressure was stable at 122/77 mmHg after 9 months and 133/83 mmHg after 12 months. Compared to the beginning of the therapy, the patient lost 3 kg of body weight. There were no serious infections, nor was an increased susceptibility to infections observed. No other serious adverse events occurred. Although the patient experienced corticosteroid-related side effects, treatment was not interrupted. After therapy, the side effects subsided and the patient reports general wellbeing.