Universal Occurrence of Glomerular Abnormalities in Patients Receiving Liver Transplants

Crawford, Darrell H. G.; Endre, Z. H.; Axelsen, Roy A.; Lynch, Stephen V.; Balderson, Glenda A.; Strong, Russell W.; Kerlin, Paul; Powell, Lawrie W.; Fleming, Simon J.

doi:10.1016/s0272-6386(12)80451-3

Cited by 66 publications

(36 citation statements)

References 12 publications

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“…Murine models of renal ischemia show that AKI directly affects liver inflammation [7,8]. Data from renal biopsy series in human subjects with advanced cirrhosis suggest that glomerular injury is a universal occurrence no matter the etiology of liver disease [11,12]. Transplant follow-up data consistently shows that pre-transplant renal dysfunction, regardless of acuity, is associated with increased longterm renal and overall survivals.…”

Section: Introductionmentioning

confidence: 99%

Acute kidney injury as a causal factor in mortality associated with hepatorenal syndrome

et al. 2011

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Hepatorenal syndrome (HRS) is a form of AKI in cirrhotic patients, which is defined as a purely physiologic derangement in renal function without any effect on renal parenchyma. Recent literature challenges this understanding. Little attention is paid to the presence of renal pathology and inflammatory alterations that occur as a result of HRS and their contribution to morbidity and mortality. In this paper, we propose that any type of AKI in the presence of liver disease is an inflammatory condition. The combination of AKI and liver failure produces a "toxic milieu" of cytokines, chemokines, and nitric oxide pathway metabolites that directly cause endothelial dysfunction affecting multiple organ systems. These global effects contribute to the increased short- and long-term mortality which has been established in the epidemiologic literature.

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Section: Introductionmentioning

confidence: 99%

Acute kidney injury as a causal factor in mortality associated with hepatorenal syndrome

et al. 2011

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“…[3][4][5][6] Another type of our center, including 70 in patients with cirrhosis. The purglomerulopathy, which resembled membranoproliferative pose of this study is to describe the spectrum of renal lesions glomerulonephritis, was later described.…”

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confidence: 99%

Transjugular renal biopsy in the treatment of patients with cirrhosis and renal abnormalities

et al. 1996

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cirrhosis. Chronic hepatitis B virus infection can also be assoWhen renal lesions are suspected in patients with circiated with various patterns of renal disease, including memrhosis, clotting disorders often preclude percutaneous branous nephropathy, membranoproliferative glomerulonerenal biopsy. This study was undertaken to determine phritis, and mesangial proliferative glomerulonephritis.10 whether transjugular renal biopsy is possible, safe, and Finally, cirrhosis caused by hepatitis C virus may be accomuseful in such patients. From 1987 to 1994, 70 patients panied by cryoglobulinemic related glomerulopathy. 11,12with cirrhosis and clotting disorders underwent transThe prevalence of cirrhosis-associated glomerular abnorjugular renal biopsies, providing renal tissue in 55. Of malities has not been clearly determined. Results of autopsy these 55 patients, 41 were Child-Pugh class B or C, 35 series are often flawed by the technical drawbacks inherent were alcoholic, serum creatinine levels were ¢130 mmol/ in the examination of postmortem renal tissue. Most patients L in 46, and proteinuria was ¢0.5 g/d in 37. Clinically in these series died of hepatocellular insufficiency, and little significant complications of transjugular renal biopsy information could be provided about previous renal function were persistent hematuria in 4 and perirenal hematoma and urinary abnormalities. 8,13,14 Series based on percutanein 4, requiring blood transfusions in 1 and 2 cases, reous renal biopsies are few and deal with patients suffering spectively. There were no deaths related to renal biopsy.from cirrhosis with moderate hepatic failure. 6,7 In the reRenal lesions were identified as glomerular in 41 (74.5%), maining patients with severe hepatic lesions, profound clotinterstitial in 7, and end-stage in 2 and were absent in ting disorders preclude percutaneous renal biopsy. This lack Transjugular renal biopsy influenced treatment in 21of information may be detrimental to patient care, particupatients (38%), including 11 who were proposed for liver larly in patients with end-stage hepatic failure and with renal transplantation and 4 who had chronic liver rejection.insufficiency who are considered for orthotopic liver transDecisions based on results of transjugular renal biopsy plantation (OLT). If renal insufficiency in these patients is were to perform liver transplantation in 8 and combined caused by the hepatorenal syndrome, renal function can rerenal and liver transplantation in 5, whereas 2 were return to reasonably good after OLT in most cases. 15 However, fused. In 6 other patients, the results of renal biopsy if renal insufficiency is caused by severe renal lesions, there modified the medical regimen. We conclude that transis a potential contraindication to OLT because of cyclosporin jugular renal biopsy may be a useful procedure in pa-A nephrotoxicity. [16][17][18][19][20] Assessment of renal histology may also tients with cirrhosis and clotting disorders. This techbe important after OLT because postoperative acute and ...

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“…We suggest that a native kidney biopsy should be performed whenever possible to assist in the diagnosis of renal failure and gauge the risk for development of recurrent disease (8 -10). Liver transplant recipients, in particular, seem to have a high frequency of glomerular abnormalities without significant clinical or biochemical evidence of renal dysfunction (11,12).…”

Section: Discussionmentioning

confidence: 99%

Increasing Referral for Renal Transplant Evaluation in Recipients of Nonrenal Solid-Organ Transplants

Chandrakantan

Mattos

Naftel

et al. 2006

Clinical Journal of the American Society of Nephrology

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The use of cyclosporine and tacrolimus therapy in nonrenal (heart, heart/lung, lung, and liver) transplantation has resulted in improved patient and graft survival. Nephrotoxicity is one of the major side effects of tacrolimus and cyclosporine therapy and may lead to ESRD. The trend of referral of nonrenal solid-organ transplant recipients for kidney transplant evaluation at a large multiorgan transplant center was examined. Records of all patients who were referred for renal transplantation at the University of Alabama between January 1, 1993, and June 30, 2004, were reviewed. Eighty (0.96%) of 8318 individuals had previously undergone a nonrenal solid-organ transplant and were included in the study. The majority (72%) of patients had their nonrenal transplants performed at the University of Alabama. Twenty-two patients had their nonrenal transplant performed elsewhere and had fewer data available for analysis. From the period 1993-1996 to 2001-2004, an 11-fold increase in the absolute number of referrals of patients with nonrenal transplants was noted. Of patients who were referred for transplant evaluation, 25 became recipients of kidney transplants with a predominance of living-donor transplants. Referral for kidney transplant evaluation among nonrenal solid-organ transplant recipients is increasing and will exacerbate the existing shortage of deceased-donor kidneys that are available for transplantation. There was a trend for liver transplant recipients compared with other solid-organ recipients to develop ESRD at a greater rate.

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Universal Occurrence of Glomerular Abnormalities in Patients Receiving Liver Transplants

Cited by 66 publications

References 12 publications

Acute kidney injury as a causal factor in mortality associated with hepatorenal syndrome

Acute kidney injury as a causal factor in mortality associated with hepatorenal syndrome

Transjugular renal biopsy in the treatment of patients with cirrhosis and renal abnormalities

Increasing Referral for Renal Transplant Evaluation in Recipients of Nonrenal Solid-Organ Transplants

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