Abstract
We present a case of IgA nephropathy (IgAN) in monozygotic twins with excellent donor and recipient outcome 11 years after transplantation. The recipient developed IgAN at 26 years and progressed to end-stage renal failure 10 years later. His identical twin who had hypertension, intermittent microscopic haematuria and positive IgA immunofluorescence on biopsy became his donor. Eleven years following transplant, in the absence of immunosuppression, the recipient has stable graft function [estimated glomerular filtration rate (eGFR) 47 mL/min/1.73 m
2
, Modification of Diet in Renal Disease (MDRD)], controlled hypertension on two medications and minor microscopic haematuria. The donor has good renal function (eGFR 51 mL/min/1.73 m
2
, MDRD), controlled hypertension on one medication and normal urine.