Percutaneous renal graft biopsy
a clinical, laboratory and pathological analysis
Keywords:
Kidney transplantation, Renal biopsy, Acute rejection, Acute tubular necrosis, GlomerulonephritisAbstract
CONTEXT: Renal allograft biopsies have been used as a good method for monitoring the evolution of kidney transplants for at least 20 years.1 Histological analysis permits differential diagnosis of the causes of allograft dysfunction to be made. OBJECTIVES: To correlate the data of urinalysis and serum creatinine with histological diagnosis of renal graft in a group of renal transplant patients. DESIGN: Accuracy study, retrospective analysis. SETTING: A university terciary referral center. SAMPLE: 339 percutaneous allograft biopsies obtained from 153 patients. Blood and urine samples were obtained before the graft biopsy. MAIN MEASUREMENTS: Laboratory evaluation and hystological analysis (light microscopy, imunofluorescent eletronic microscopy). RESULTS: Most of the biopsies (58.9%) were performed during the first month post-transplant. An increase in serum creatinine was associated with acute tubular and/or cortical necrosis. Proteinuria and normal serum creatinine were associated with glomerular lesions. Non-nephrotic range proteinuria and an increase in serum creatinine were associated with chronic rejection. CONCLUSIONS: Evaluation of serum creatinine and urinalysis can be useful in suggesting the histological graft diagnosis.
Downloads
References
Matas AJ, Sibley R, Mauer M, Sutherland DER, Simmons RL, Najarian JS. The value of needle allograft biopsy. I: A retrospective study of biopsies performed during putative rejection episodes. Ann Surg 1983;197:226-37.
Matas AJ, Tellis VA, Sablay L, Quinn T, Sobberman R, Veith FJ. The value of needle allograft biopsy. III: A prospective study. Surgery 1985;98:922-5.
Wilckzek HE. Percutaneous needle biopsy of the renal allograft. A safety evaluation of 1129 biopsies. Transplantation 1990;50:790-7.
Cameron JS. Glomerulonephritis in renal transplant. Transplantation 1982;34:237-45.
Cheigh JS, Stenzel KH, Susin M, Rubin AL, Riggio RR, Withel JC. Kidney transplant nephrotic syndrome. Am J Med 1974;57:730-40.
Cheigh JS, Mouradian J, Susin M et al. Kidney transplant nephrotic syndrome: relationship between allograft histopathology and natural course. Kidney Int 1990;18:358
Shapiro RS, Deshmukl A, Kropp K. Massive post-transplant proteinuria. Transplantation 1976;22:489-92.
Brophy D, Najarian JS, Kjelstrand CM. Acute tubular necrosis after renal transplantation. Transplantation 1980;29:245.
Kjellstrand CM, Casall RE, Simmons RL, Shiderman JR, Buselmeier TJ, Najarian JS. Etiology and prognosis in acute post-transplant renal failure. Am J Med 1976;61:190
Hayry P, Soots A, VonWillebrand E, Wicktonwics K. Composition, subclass distribution and preliminary analysis on the functions of host inflammatory cells infiltrating renal allografts during rejection. Transpl Proc 1979;2:785.
Schroeder TJ, Weiss MA, Smith RD, Stephens GW, Carey M, First MR. The use of OKT3 in the treatment of acute vascular rejection. Transpl.Proc 1991;23:1043.
Tilney NL, Whithey WD, Diamond JR, Kupiec-Weglisnki JW, Adams DH. Chronic rejection: an undefined conundrum. Transplantation 1991;52:389.
McPhaul J, Thompson A, Lorden R. Evidence suggesting persistence of nephritogenic immunopathologic mechanisms in patients receiving a renal allograft. J Clin Invest 1973;52:1059.
Rosemberg HG, Martinez PS, Vacarezza AS, Martinez LV. Morphological findings in 70 kidneys of living donors for renal transplant. Path Res Pract 1990;186:619.
Santelli G, Hiesse C, Schovaert D et al. Pathology of two-year renal biopsies in cyclosporine and conventionally immunosuppressed renal transplant patients. Transpl Proc 1989;21:1674.
Bergstrand A, Bohman SO, Farnsworth A. Renal histopathology in kidney transplant recipients immunosuppressed with cyclosporine A: results of an international workshop. Clin Nephrol 1985;24:107
Braun WE. Long term complications of renal transplantation. Kidney Int 1990;37:1363.
Farnsworth A, Hall BM, Ng ABP. Renal biopsy morphology in renal transplantation. Am J Surg Pathol 1984;8:243.
