Natural Anticoagulant and Fibrinolytic Pathways in Renal Allograft Failure

Torry, Ronald J.; Ca, Labarrere; Gargiulo, Patrizia; Wp, Faulk

doi:10.1097/00007890-199410270-00012

Cited by 17 publications

(17 citation statements)

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“…a polyclonal antibody to antithrombin produced characteristic reactivities in smooth muscle cells of arteries and arterioles, arterial intima, and with venous endothelium, as previously reported (Absher et al 1992;Torry et al 1994). Capillary antithrombin reactivity was generally present only in microvasculature bordering distal tubules that lacked intraepithelial antithrombin reactivity, whereas capillaries surrounding PCTs that contained granular intraepithelial antithrombin were consistently antithrombin-negative.…”

Section: Vascular Antithrombin Renal Sections Reacted Withsupporting

confidence: 73%

“…Immunohistochemistry for T-cell, macrophage, and neutrophil infiltrates as well as vascular antithrombin was performed as described (Torry et al 1994). All sections were coverslipped with aqueous mounting medium and the sections were studied by epi-illumination in a Leitz Orthoplan microscope fitted with interference optics.…”

Section: Immunohistological Techniquesmentioning

confidence: 99%

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Localization and Characterization of Antithrombin in Human Kidneys

Torry

Labarrere

Nelson

et al. 1999

J Histochem Cytochem.

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Antithrombin is a serine protease inhibitor that is critical in maintaining a thromboresistant vasculature. The association between low serum antithrombin concentration and renal disease suggests that the kidney plays a role in the conservation of plasma antithrombin. We used immunohistochemical techniques to determine the spatial distribution, heparin binding characteristics, and intracellular and intercellular localization of antithrombin in biopsy specimens (n = 53) of human donor kidneys obtained at the time of transplantation. In the renal cortex, double antibody techniques demonstrated the presence of intracellular antithrombin in proximal tubule epithelial cells. The reactivity was granular and was co-localized with vesicle-like structures. Distal and collecting tubules did not demonstrate intraepithelial antithrombin reactivity. No tubule structures in the medullary region demonstrated intracellular antithrombin, but all these structures showed intense basement membrane antithrombin reactivity. Double antibody techniques also demonstrated that the heparin binding domain of intraepithelial antithrombin was occupied. Semiquantitative scores for intraepithelial antithrombin were significantly decreased in renal biopsy specimens obtained 30 min after anastomosis compared with biopsies from the same organ obtained before anastomosis. These findings suggest that antithrombin, probably in association with heparin or heparan sulfate, is internalized by renal proximal epithelial cells. Although the ultimate fate of intraepithelial antithrombin is not known, this may represent a mechanism by which the kidney helps to maintain plasma antithrombin concentrations.

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Section: Vascular Antithrombin Renal Sections Reacted Withsupporting

confidence: 73%

Section: Immunohistological Techniquesmentioning

confidence: 99%

Localization and Characterization of Antithrombin in Human Kidneys

Torry

Labarrere

Nelson

et al. 1999

J Histochem Cytochem.

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“…Prothrombotic alterations in hemostatic parameters are also found in graft vessels, suggesting the localized activation of coagulation. Markedly reduced vascular antithrombin, thrombomodulin, and tissue plasminogen activator reactivity was demonstrated in biopsy specimens from 44 failed allografts, suggesting a localized prothrombotic vascular milieu (47). Renal allografts that failed within 1 month after transplantation had a significantly greater depletion of vascular antithrombin and more extensive fibrin deposition than those that failed later.…”

Section: Other Thrombophilic Defects and Predisposing Factorsmentioning

confidence: 96%

Thrombophilia and Thrombotic Problems in Renal Transplant Patients

Kujovich¹

2004

Transplantation

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“…The overall incidence is 2-12% [6][7][8] with the highest risk in children <2 years [9] and 2-6 years of age [10]. Thrombosis of the renal vein is more frequent and usually causes pain in combination with swelling of the organ [11].…”

Section: Renovascular Thrombosismentioning

confidence: 99%

Do we need screening for thrombophilia prior to kidney transplantation?

Andrassy¹

2004

Nephrology Dialysis Transplantation

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Background. There is increased risk for the occurrence of deep venous thrombosis (DVT) and renovascular thrombosis after kidney transplantation. A disruption of the blood homeostasis caused by surgery and leading to clotting and bleeding malfunctions is widely accepted. However, other causes such as inherited or acquired disorders of the clotting system may further increase the risk of thrombosis. Here, we summarize and review data on possible causes, incidence and ways to prevent the occurrence of DVT and/or renovascular thrombosis after kidney transplantation. Results. The incidence of DVT after kidney transplantation is 6.2-8.3% and 25% of these patients suffer from pulmonary embolism. The DVT occurs primarily on the side of the transplant with an increased risk throughout the first 5 months after transplantation. Thereby, 2-12% of the patients develop renovascular thromboses, most of which are related directly to the surgery. However, inherited or acquired thrombophilia may also play an important role. A severe course is known for prothrombin gene G20210A polymorphism, which can result in graft loss. A great diversity of prophylactic treatments is available but adjustment to the underlying circumstances is crucial for a favourable outcome. Low-dose heparin prophylaxis for at least 2-3 weeks can be used as standard therapy to prevent the occurrence of DVT after kidney transplantation. However, this may not be sufficient for concurrent disorders of the blood homeostasis such as elevated levels of antiphospholipid antibodies, lupus anticoagulant, prothrombin gene G20210A polymorphism or a combined inherited thrombophilia. These patients may need a prophylactic anticoagulation with coumarins starting prior to transplantation and being continued for at least 1 year or even lifelong. Only randomized trials can answer the question concerning optimal duration and safety of coumarins in this setting.Conclusions. DVT and/or renovascular thromboses are severe complications after kidney transplantation. Inherited and acquired thrombophilia, apart from surgery and abnormal anatomy itself, have to be considered and proper prophylactic treatment initiated.

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Natural Anticoagulant and Fibrinolytic Pathways in Renal Allograft Failure

Cited by 17 publications

References 0 publications

Localization and Characterization of Antithrombin in Human Kidneys

Localization and Characterization of Antithrombin in Human Kidneys

Thrombophilia and Thrombotic Problems in Renal Transplant Patients

Do we need screening for thrombophilia prior to kidney transplantation?

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