Histopathology of renal failure after heart transplantation: a diverse spectrum
| Autor: | Anelechi C. Anyanwu, Michael J. Domanski, Revathi Balakrishnan, Sean Pinney, Steven H. Dikman, Ajith Nair, Kimmarie Hammond, Graciela deBoccardo |
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| Rok vydání: | 2011 |
| Předmět: |
Pulmonary and Respiratory Medicine
Nephrology Male medicine.medical_specialty Pathology medicine.medical_treatment Biopsy Urology Renal function Kidney Cohort Studies Renal Dialysis Internal medicine medicine Humans Diabetic Nephropathies Renal Insufficiency Kidney transplantation Aged Retrospective Studies Heart transplantation Transplantation Nephrosclerosis medicine.diagnostic_test business.industry Glomerulosclerosis Focal Segmental Middle Aged medicine.disease Kidney Transplantation Disease Progression Heart Transplantation Surgery Female Renal biopsy Cardiology and Cardiovascular Medicine business Cardiomyopathies Kidney disease |
| Zdroj: | The Journal of heart and lung transplantation : the official publication of the International Society for Heart Transplantation. 31(3) |
| ISSN: | 1557-3117 |
| Popis: | Background Chronic kidney disease occurs frequently after heart transplantation and is associated with significant morbidity and mortality. Herein we describe the histopathology associated with renal failure in a cohort of heart transplant recipients. Methods Over a 4-year period all patients with an estimated GFR 2 or significant proteinuria were referred to the kidney transplant clinic for clinical evaluation. A percutaneous renal biopsy was performed as part of a standardized evaluation. Results Eighteen patients underwent renal biopsy 5.8 ± 4.1 years after transplantation. Hypertension (88.9%), Type 2 diabetes (55.6%) and allograft vasculopathy (38.9%) were prevalent. All patients were receiving calcineurin inhibitors. Mean creatinine was 2.9 ± 1.2 mg/dl with an estimated GFR 27.9 ± 9.1 ml/min/1.73 m 2 . Eight patients (44%) had proteinuria >1 g per 24 hours. The major histologic findings were nephrosclerosis plus diabetic glomerulopathy (50%), nephrosclerosis and focal segmental glomerulosclerosis (22.2%) and nephrosclerosis alone (22.2%). One patient had direct CNI toxicity consisting of nodular sub-adventitial hyalinosis. Eleven patients (61.1%) had glomerular disease and 11 patients (61.1%) had moderate or severe tubular atrophy. During follow-up, 5 patients (27.8%) started hemodialysis, 4 (22.2%) died, and 2 (11.1%) received a renal transplant. Conclusions We observed diverse histologic patterns in this series of renal biopsies suggesting that chronic kidney disease after heart transplantation has a complex and varied pathologic basis. Further defining the renal injuries that precede heart transplantation and predispose to the progression of kidney disease after transplant may assist in treating this population. |
| Databáze: | OpenAIRE |
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