Focal Glomerulosclerosis in Renal Allografts

Abstract

Focal segmental and/or global sclerotic glomerular lesions with hyalinosis were noted in three allografts in association with the nephrotic syndrome (NS) and chronic rejection (CR). Similar lesions were absent in eight allografts with CR without NS. Previous reports have stressed the presence of this lesion in allografts with recurrence of the disease entity "idiopathic nephrotic syndrome with focal glomerulosclerosis". Both clinical and pathologic evidence suggest that recurrence was not a factor in the pathogenesis of the lesion in the three allografts with CR and NS. The presence of these lesions in failing allografts may represent the result of CR with associated NS rather than recurrence of the disease entity.

Hyperfiltration, creatinine clearance and chronic graft loss

“…The immunosuppressive regime underwent several changes. Virtually all patients received high dose steroids, tapered over several months to [5][6][7][8][9][10] mg prednisone daily. The falls rapidly after transplantation, the incidence of chronic graft loss follows a log-linear course.…”

“…tubular atrophy and variable glomerular changes: atrophy. hypertrophy, "transplant glomcrulopathy" and glomerulosclerosis (3)(4)(5)(6)(7). The prognosis of CRAD has not changed during the past 25 yr. in contrast to acute rejection, where dramatic improvements in prognosis due to changes in immunosuppressive regimes have been seen (8).…”

“…Chronic renal allograft dysfunction (CRAD), apart from a minority of cases caused by recurrent renal disease, urological or vascular complications (1, 2), is a disease entity characterised by varying degrees of narrowing of the graft arteries and arterioles, interstitial cellular infiltration and fibrosis, tubular atrophy and variable glomerular changes: atrophy, atrophy. hypertrophy, hypertrophy, “transplant glomerulopathy” and glomerulosclerosis (3‐7). The prognosis of CRAD has not changed during the past 25 yr, in contrast to acute rejection, where dramatic improvements in prognosis due to changes in immunosuppressive regimes have been seen (8).…”