Functional and morphologic evaluation of kidney proximal tubuli and correlation with renal allograft prognosis
Functional and morphologic evaluation of kidney proximal tubuli and correlation with renal allograft prognosis
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DOI：
10.1111/j.1432-2277.2009.01005.x
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发表时间：
2010-05-01
影响因子：
3.1
通讯作者：
Pacheco-Silva, Alvaro
中科院分区：
文献类型：
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作者：
Carvalho de Matos, Ana Cristina;Saraiva Camara, Niels Olsen;Pacheco-Silva, Alvaro
移植肾功能稳定且近端肾小管功能障碍（PTD）的患者发生慢性同种异体移植肾病（CAN）的风险增加。在这项研究中，我们研究了与PTD相关的组织学模式及其与移植物预后的关系。49例移植物功能稳定的移植患者接受了活检。同时测定尿视黄醇结合蛋白（uRBP）和肌酐清除率。采用Banff评分和半定量组织学分析来评估小管间质改变。随访24.0±7.8个月。活检时，平均血清肌酐为1.43±0.33 mg/dl。12例（24.5%）患者uRBP >= 1 mg/l，提示PTD， 67%活检有不同程度的小管间质损伤。在研究期结束时，18例（36.7%）患者肾功能丧失。uRBP水平与间质纤维化和小管萎缩（IF/TA）、天狼星红测量的间质纤维化或小管间质损伤的形态学结果无关。然而，在多变量分析中，与肾功能丧失相关的唯一变量是uRBP水平>= 1 mg/l，决定了肾功能丧失的风险为5.290 （P = 0.003）。肾移植患者出现PTD有功能改变，但与形态学改变无关。这种功能改变与肾功能的进行性下降有关。
P>Renal transplant patients with stable graft function and proximal tubular dysfunction (PTD) have an increased risk for chronic allograft nephropathy (CAN). In this study, we investigated the histologic pattern associated with PTD and its correlation with graft outcome. Forty-nine transplant patients with stable graft function were submitted to a biopsy. Simultaneously, urinary retinol-binding protein (uRBP) was measured and creatinine clearance was also determined. Banff's score and semi-quantitative histologic analyses were performed to assess tubulointerstitial alterations. Patients were followed for 24.0 +/- 7.8 months. At biopsy time, mean serum creatinine was 1.43 +/- 0.33 mg/dl. Twelve patients (24.5%) had uRBP >= 1 mg/l, indicating PTD and 67% of biopsies had some degree of tubulointerstitial injury. At the end of the study period, 18 (36.7%) patients had lost renal function. uRBP levels were not associated with morphologic findings of interstitial fibrosis and tubular atrophy (IF/TA), interstitial fibrosis measured by Sirius red or tubulointerstitial damage. However, in multivariate analysis, the only variable associated with the loss of renal function was uRBP level >= 1 mg/l, determining a risk of 5.290 of loss of renal function (P = 0.003). Renal transplant patients who present PTD have functional alteration, which is not associated with morphologic alteration. This functional alteration is associated to progressive decrease in renal function.