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논문분류	춘계학술대회 초록집
제목	Narsoplimab treatment for recurrent IgA nephropathy stabilized eGFR and proteinuria
저자	Amar Sethi
출판정보	2023; 2023(1):
키워드
초록	Introduction:IgA nephropathy (IgAN) recurrence is a risk post-transplantation, and treatment options are limited. The complement system plays an important role in the pathogenesis of IgAN. Narsoplimab is an investigational monoclonal antibody that targets the effector enzyme of the lectin pathway of complement, MASP-2. We report a case study of the complement inhibitor narsoplimab for treatment of recurrent IgAN. Case Description:A 53-year-old male with hypertension diagnosed with IgAN in 2010 underwent a living-related kidney transplant in 2014. Transplant biopsy in 2019 due to rising proteinuria (peak urine protein:creatinine ratio [uPCR] 429 g/mol) revealed strong mesangial positivity for IgA with weaker C3 staining. Electron microscopy supported diagnosis of recurrent IgAN. The patient was monitored for 17 months with repeat biopsy undertaken in Nov 2020 due to falling estimated glomerular filtration rate (eGFR, 30 ml/min/1.73m2), rising uPCR (818 g/mol), and symptomatic worsening oedema. The patient was treated with budesonide, along with compassionate use narsoplimab, which was started Feb 2021 for 18 weeks, and completed Jul 2021 (Figure 1). In the 6 months prior to narsoplimab treatment, eGFR declined by 50%; however, during narsoplimab treatment, eGFR decline was reduced to ~31%, suggesting possible stabilization. uPCR from start to end of treatment decreased dramatically from 1,191 g/mol to 467 g/mol. A biopsy taken in Jul 2021 showed features of advanced recurrent IgAN. The patient received 6 more infusions of narsoplimab between Dec 2021 and Jan 2022, but subsequently progressed to end-stage kidney disease and began dialysis. Discussion:We report stabilization of eGFR and uPCR with narsoplimab treatment in a patient with recurrent IgAN. The lack of complement degradation products seen with immunofluorescence on kidney biopsy post-treatment suggests that stabilization is due to complement inhibition. Further investigations of narsoplimab use in progressive recurrent IgAN are being explored.
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