Glomerular Neovascularization in Nondiabetic Renal Allograft Is Associated with Calcineurin Inhibitor Toxicity
Glomerular Neovascularization in Nondiabetic Renal Allograft Is Associated with Calcineurin Inhibitor Toxicity
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DOI：
10.1159/000511452
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发表时间：
2020-11-25
期刊：
影响因子：
2.5
通讯作者：
Shimizu，Akira
中科院分区：
文献类型：
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作者：
Sawada，Anri;Okumi，Masayoshi;Shimizu，Akira
目的：肾小球外输出小动脉（extra efferent arterioles，又称极血管（polar vasculosis，PV））常位于肾小球血管极，与肾小球肥大有关，提示移植肾早期复发性糖尿病肾病（diabetic kidney disease，DKD）。然而，它的意义，在没有糖尿病的患者仍然unertious.MethodsA共9，004肾移植活检标本之间获得的2007年1月和2017年12月在东京女子医科大学进行了回顾性分析，以检查PV在肾移植的临床和病理意义。在165例患者的186份活检标本中发现了PV。PV组包括46例患者; 35例无DKD的患者和11例DKD作为ESRD的初始原因的患者，其临床信息可用并接受钙调磷酸酶抑制剂（CNI）他克莫司治疗。非PV组包括年龄和术后一天相匹配的肾移植患者，包括93例无DKD和16例DKD作为ESRD.ResultsIn非糖尿病肾移植患者的初始原因，收缩压显着高于PV组比非PV组。在整个研究期间以及移植后2周、1个月和2年，PV组的他克莫司谷浓度显著高于非PV组。肾小球肥大明显更常见。此外，PV组的Banff评分中ah和aah评分显著高于非PV组。在糖尿病肾移植，虽然在所有时间段的临床参数和他克莫司谷水平之间的PV和非PV组没有显着差异，AH评分显着较高的PV group.ConclusionPV与CNI毒性在非糖尿病，但不是在糖尿病肾移植。移植肾PV的发病机制被认为是多因素的。
IntroductionExtra efferent arterioles, also known as polar vasculosis (PV), are often observed in the glomerular vascular pole and are associated with glomerular hypertrophy, indicating early recurrent diabetic kidney disease (DKD) in renal allografts. However, its significance in patients without diabetes remains uncertain.MethodsA total of 9,004 renal allograft biopsy specimens obtained between January 2007 and December 2017 at Tokyo Women’s Medical University were retrospectively analyzed to examine the clinical and pathological significance of PV in renal allografts. PV was identified in 186 biopsy specimens obtained from 165 patients. The PV group comprised 46 patients; 35 patients without DKD and 11 patients with DKD as the initial cause of ESRD, whose clinical information was available and treated with the calcineurin inhibitor (CNI) tacrolimus. The non-PV group comprising patients with renal allografts matched for age and postoperative day included 93 patients without DKD and 16 patients with DKD as the initial cause of ESRD.ResultsIn patients with nondiabetic renal allografts, systolic blood pressure was significantly higher in the PV group than in the non-PV group. The trough tacrolimus levels during the overall study period and at 2 weeks, 1 month, and 2 years after transplantation were significantly higher in the PV group compared with the non-PV group. Glomerulomegaly was significantly more common. Moreover, ah and aah scores in Banff score were significantly higher in the PV group than in the non-PV group. In those with diabetic renal allografts, although the clinical parameters and tacrolimus trough levels in all time periods were not significantly different between the PV and non-PV groups, the ah score was significantly higher in the PV group.ConclusionPV was associated with CNI toxicity in nondiabetic but not in diabetic renal allografts. The pathogenesis of PV in renal allografts is considered to be multifactorial.