Medullary ray injury in renal allografts
Medullary ray injury in renal allografts
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DOI：
10.1111/j.1440-1827.2010.02593.x
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发表时间：
2010-11-01
影响因子：
2.2
通讯作者：
Yamaguchi, Yutaka
中科院分区：
文献类型：
--
作者：
Kobayashi, Akimitsu;Yamamoto, Izumi;Yamaguchi, Yutaka
导致同种异体肾移植物中间质纤维化和肾小管萎缩（IF/TA）的非免疫损伤有多种病因，但尚未开发出病理学验证手段。髓质射线损伤 (MRI) 是许多诱导 IF/TA 的非免疫损伤的病理特征，也是钙调神经磷酸酶抑制剂 (CNI) 毒性进行病理学测定导致条纹纤维化的病理特征。我们研究了 CNI 毒性对 MRI 和其他与 IF/TA 相关的非免疫病因的影响。在这项研究中，MRI 被定义为仅局限于髓质射线的纤维化和炎症。对 36 个显示 MRI 的活检方案进行了分析，并在组织病理学上分类如下： 与 CNI 毒性相关的 MRI；慢性梗阻或反流性肾病；以及急性或慢性肾盂肾炎。 MRI 的病因为 CNI 毒性 (n = 16, 44.4%)、慢性梗阻 (n = 13, 36.1%)、急慢性肾盂肾炎 (n = 2, 5.6%) 和其他 (n = 5, 13.9%)。我们对 7 例与慢性梗阻或反流性肾病相关的 MRI 病例和 6 例显示膀胱输尿管反流的病例进行了膀胱造影。 36 例中有 30 例一年后 ci+ct 评分显示显着进展（1.53 +/- 1.04 对比 3.03 +/- 1.13，P < 0.01）。 MRI 有多种病因，也可以预测泌尿系统并发症的变化。 MRI 的分类可能有助于确定导致 IF/TA 的非免疫病因。
Non-immune injury leading to interstitial fibrosis and tubular atrophy (IF/TA) in renal allografts has various etiologies, but pathological means of verification have yet to be developed. Medullary ray injury (MRI) is a pathological feature of many non-immune injuries inducing IF/TA and pathological determination of calcineurin inhibitor (CNI) toxicity proceeding to striped fibrosis. We investigated the contribution of CNI toxicity to MRI and other non-immune etiologies related to IF/TA. In this study MRI is defined as fibrosis and inflammation localized exclusively to the medullary ray. Thirty-six protocol biopsies showing MRI were analyzed and classified histopathologically as following: MRI related to CNI toxicity; chronic obstruction or reflux nephropathy; and acute or chronic pyelonephritis. The etiology of MRI was CNI toxicity (n = 16, 44.4%), chronic obstruction (n = 13, 36.1%), acute or chronic pyelonephritis (n = 2, 5.6%), and other (n = 5, 13.9%). We performed cystography in seven cases of MRI related to chronic obstruction or reflux nephropathy and six cases showing vesicoureteral reflux. The ci+ct score showed significant progression after one year in 30 of the 36 cases (1.53 +/- 1.04 vs. 3.03 +/- 1.13, P < 0.01). MRI has various etiologies and may also predict changes in urological complications. The classification of MRI may be useful to determine the non-immune etiology leading to IF/TA.