Renal glomerular lesions in unselected patients with cirrhosis undergoing orthotopic liver transplantation

Pathophysiology of renal disease associated with liver disorders: Implications for liver transplantation. Part I

“…30 These descriptions have been gleaned largely from analysis of unselected autopsy specimens or renal biopsy specimens from cirrhotic patients with proteinuria or hematuria. 30 However, the general influence of hepatic disease on renal pathological characteristics also has been shown by Axelson et al 16 from biopsies performed at the time of liver transplantation in consecutive unselected patients. Such biopsy specimens showed mild glomerular changes in 12 of 23 patients and occasional tubular injury.…”

“…16,28 IgA is the most prominently deposited immunoglobulin within the mesangium and subendothelial space, although IgG and IgM also are seen. 1,16,28 Mesangial expansion in conjunction with hepatic failure likely occurs in part because of nonspecific mesangial deposition of macromolecules, such as abnormal IgA aggregates, that are normally cleared by interaction with hepatic and white blood cell receptors in the presence of good hepatic function. 29 However, the major mechanism responsible for glomerulosclerosis is not known.…”

“…These changes usually are glomerular and have been labeled hepatic glomerulosclerosis. 1,16,27 Hepatic glomerulosclerosis is characterized by variable degrees of mesangial expansion, thickening of capillary walls, a modest increase in endothelial and epithelial cell size and number, and deposits of immunoglobulins and electron-dense material in the mesangium and capillary walls ( Fig. 1).…”

“…Renal diseases may be divided into several categories, including glomerulonephritis (membranoproliferative glomerulonephritis [MPGN], membranous nephropathy, immunoglobulin A [IgA] nephropathy, mesangial proliferative glomerulonephritis, vasculitis [both antineutrophil cytoplasmic autoantibody and/or anti-glomerular basement membrane antibody positive], and fibrillary glomerulopathy), tubulointerstitial nephritis (Sjögren's syndrome, sarcoidosis, secondary oxalosis), metabolic diseases (primary hyperoxaluria, methylmalonic aciduria), and structural diseases (cystic renal disease). 1,[10][11][12][13][14][15][16][17] Primary biliary cirrhosis and primary sclerosing cholangitis most often are associated with antineutrophil cyto-plasmic autoantibody-positive vasculitis and membranous nephropathy. 18,19 Hepatitis C virus (HCV) infection is associated primarily with MPGN, but fibrillary glomerulonephritis also is seen.…”

Preoperative evaluation of patients awaiting liver transplantation: Comparison of multiphasic contrast‐enhanced 3D magnetic resonance to helical computed tomography examinations

“…Drawbacks of CT include the risks associated with iodinated contrast material and exposure to ionizing radiation. Because renal dysfunction often complicates the course of liver transplantation candidates (11,12), iodinated contrast-associated nephrotoxicity is an important consideration in these patients.…”