Clinicopathologic Impact of Early Medullary Ray Injury in Patients Following Kidney Transplantation

被引：1

作者：

Niikura, T. ^{[1
]}

Kobayashi, A. ^{[1
]}

Kawabe, M. ^{[1
]}

Katsuma, A. ^{[1
]}

Yamakawa, T. ^{[1
]}

Katsumata, H. ^{[1
]}

Mafune, A. ^{[1
]}

Nakada, Y. ^{[1
]}

Yamamoto, I. ^{[1
]}

Tanno, Y. ^{[1
]}

Ohkido, I. ^{[1
]}

Okumi, M. ^{[2
]}

Ishida, H. ^{[2
]}

Yamamoto, H. ^{[3
]}

Yokoo, T. ^{[1
]}

Tanabe, K. ^{[2
]}

机构：

[1] Jikei Univ, Sch Med, Dept Internal Med, Tokyo, Japan

[2] Tokyo Womens Med Univ, Dept Urol, Tokyo, Japan

[3] Atsugi City Hosp, Dept Internal Med, Kanagawa, Japan

来源：

TRANSPLANTATION PROCEEDINGS | 2017年 / 49卷 / 01期

关键词：

CYCLOSPORINE NEPHROPATHY; UROLOGICAL COMPLICATIONS; RENAL-TRANSPLANTATION; VESICOURETERAL REFLUX; CLINICAL IMPACT; NEPHROTOXICITY; FIBROSIS;

D O I：

10.1016/j.transproceed.2016.10.021

中图分类号：

R392 [医学免疫学]; Q939.91 [免疫学];

学科分类号：

100102 ;

摘要：

Background. Previously, we explored the histopathologic characteristics of medullary ray injury (MRI) inducing interstitial fibrosis and tubular atrophy (IF/TA) to determine its etiologies, which include calcineurin inhibitor (CNI) toxicity and urologic complications. However, we did not examine the effects of these etiologies on long-term kidney allograft prognosis, because biopsy timing differed among cases. Aim. We examined the influence of early MRI on kidney allograft prognosis using protocol biopsies taken within a 3-month time frame. Methods. We defined early MRI as tubular degeneration with interstitial edema or mild fibrosis localized to the medullary ray. We divided 53 protocol biopsies into 2 groups, with and without early MRI. Early MRI+ cases with isometric vacuolization were classified as CNI toxicity; those with Tamm-Horsfall protein in the interstitium and a thyroidlike appearance were classified as urinary tract system abnormalities; remaining cases were classified as "others." We compared changes in serum levels of creatinine (sCr) over 3 years and fibrosis extent at 1 year. Results. The sCr levels were significantly higher in the MRI+ group than the MRI group at 3 years (P = .024). Examining the 3 MRI+ subgroups, only the MRI+ urinary tract system abnormalities group had significantly high sCr levels compared to the MRI group (P = .019). The MRI+ group showed significant signs of IF/TA at 1 year. Conclusions. Early MRI after kidney transplantation was significantly more likely to develop IF/TA at 1 year and had higher sCr levels at 3 years. In such cases, intervention might preserve graft function over the long term.

引用

页码：78 / 83

页数：6

共 17 条

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