Protocol graft biopsy in kidney transplantation

Sakai, Ken; Oguchi, Hideyo; Muramatsu, Masaki; Shishido, Seiichiro

doi:10.1111/nep.13282

Cited by 21 publications

(15 citation statements)

References 37 publications

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“…At the time of recurrence renal function may be reduced or normal with a progressive graft loss extremely variable [ 2 ]. Nevertheless, even chronic rejection may manifest with progressive deterioration of kidney function, proteinuria, and hypertension, potentially being clinically indistinguishable from recurrence [ 21 ].…”

Section: Clinical Features and Differential Diagnosismentioning

confidence: 99%

“…The presence of tubulitis (the presence of mononuclear cells in the basolateral aspect of the renal tubule epithelium) and interstitial inflammation suggest T Cell-Mediated Rejection (TCMR) [ 24 , 25 ]. The presence of striped interstitial fibrosis, tubular atrophy, and nodular arteriolar hyalinosis are suggestive of CNI Nephrotoxicity [ 21 ]. These changes are due to the increased level of TGF-β that promotes the development of fibrosis and epithelial–mesenchymal transition in which mesenchymal or epithelial cells can turn into fibroblasts, leading to fibrosis [ 26 ].…”

Section: Clinical Features and Differential Diagnosismentioning

confidence: 99%

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Recurrent Glomerulonephritis after Renal Transplantation: The Clinical Problem

Infante

Rossini

Leo

et al. 2020

IJMS

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Glomerulonephritis (GN) continues to be one of the main causes of end-stage kidney disease (ESKD) with an incidence rating from 10.5% to 38.2%. Therefore, recurrent GN, previously considered to be a minor contributor to graft loss, is the third most common cause of graft failure 10 years after renal transplantation. However, the incidence, pathogenesis, and natural course of recurrences are still not completely understood. This review focuses on the most frequent diseases that recur after renal transplantation, analyzing rate of recurrence, epidemiology and risk factors, pathogenesis and bimolecular mechanisms, clinical presentation, diagnosis, and therapy, taking into consideration the limited data available in the literature. First of all, the risk for recurrence depends on the type of glomerulonephritis. For example, recipient patients with anti-glomerular basement membrane (GBM) disease present recurrence rarely, but often exhibit rapid graft loss. On the other hand, recipient patients with C3 glomerulonephritis present recurrence in more than 50% of cases, although the disease is generally slowly progressive. It should not be forgotten that every condition that can lead to chronic graft dysfunction should be considered in the differential diagnosis of recurrence. Therefore, a complete workup of renal biopsy, including light, immunofluorescence and electron microscopy study, is essential to provide the diagnosis, excluding alternative diagnosis that may require different treatment. We will examine in detail the biomolecular mechanisms of both native and transplanted kidney diseases, monitoring the risk of recurrence and optimizing the available treatment options.

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Section: Clinical Features and Differential Diagnosismentioning

confidence: 99%

Section: Clinical Features and Differential Diagnosismentioning

confidence: 99%

Recurrent Glomerulonephritis after Renal Transplantation: The Clinical Problem

Infante

Rossini

Leo

et al. 2020

IJMS

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“…Second, the possibility of intraoperative influences was not considered when interpreting 1-h biopsies. Some troubles during surgery, such as bleeding from the anastomosis and acute tubular necrosis after reperfusion, may affect the kidney biopsy result [ 26 ]. These influences should have been accounted for.…”

Section: Discussionmentioning

confidence: 99%

“…Baseline kidney biopsy was defined as a biopsy performed at 1 hour after reperfusion during the kidney transplantation [ 26 ]. Baseline biopsy data were collected retrospectively from the pathological reports.…”

Section: Methodsmentioning

confidence: 99%

HbA1c and Aortic Calcification Index as Noninvasive Predictors of Pre-Existing Histopathological Damages in Living Donor Kidney Transplantation

Tanaka

Yamanaga

Hidaka

et al. 2020

JCM

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We previously reported that allografts from living donors may have pre-existing histopathological damages, defined as the combination of interstitial fibrosis (ci), tubular atrophy (ct), and arteriolar hyalinosis (ah) scores of ≧1, according to the Banff classification. We examined preoperative characteristics to identify whether the degree of these damages was related to metabolic syndrome-related factors of donors. We conducted a single-center cross-sectional analysis including 183 living kidney donors. Donors were divided into two groups: chronic change (ci + ct ≧ 1 ∩ ah ≧ 1, n = 27) and control (n = 156). Preoperative characteristics, including age, sex, blood pressure, hemoglobin A1c (HbA1c), aortic calcification index (ACI), and psoas muscle index (PMI), were analyzed. Comparing the groups, the baseline estimated glomerular filtration rate was not significantly different; however, we observed a significant difference for ACI (p = 0.009). HbA1c (p = 0.016) and ACI (p = 0.006) were independent risk factors to predict pre-existing histopathological damages, whereas PMI was not. HbA1c correlated with ct scores (p = 0.035), and ACI correlated with ci (p = 0.005), ct (p = 0.021), and ah (p = 0.017). HbA1c and ACI may serve as preoperative markers for identifying pre-existing damages on the kidneys of living donors.

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“…[ 5 6 ] Moreover, posttransplant renal pathology deals not only with the evaluation of rejection but also with posttransplant functional alterations whose morphological correlation on histology greatly overlaps with primary nephropathy diagnosis in terms of time-consuming assessment of biopsy with many different ancillary techniques. [ 7 8 ] The glomerular compartment is often the most affected in kidney functional tissue and despite increasing research in soluble and molecular markers of disease, kidney biopsy remains the gold standard for many glomerulopathies. [ 9 10 11 ] Some different considerations concern the evaluation of preimplantation kidney biopsy.…”

mentioning

confidence: 99%