Fevzi ERSOY, Fatih YILMAZ, Hüseyin KOÇAK, Bahar AKKAYA, Serap TORU, Gültekin SÜLEYMANLAR, Ramazan ÇETİNKAYA, Feyza BORA

Böbrek Nakli Alıcılarında Histopatolojik ve Laboratuvar Bulguları Arasındaki İlişki

Amaç: Bu retrospektif çalışmada, böbrek nakli olan hastaların yüksek kreatinin düzeyi ve proteinüri nedenlerini bulmayı amaçladık.Gereç ve Yöntemler: Araştırma verileri hasta dosyalarından ve hastane veri tabanından alınmıştır.Bulgular: 92 hastadan böbrek greft biyopsisi alındı. 24'ü kadın, 68'i erkekti. Biyopsilerin histopatolojik incelemesinde 20 sınırda değişiklik, 2 akut antikor aracılı rejeksiyon AAAR , 10 kronik aktif AAR, 7 akut T hücre aracılı rejeksiyon THAR , 8 birincil hastalık nüksü veya de novo glomerulonefrit, 1 koagülasyon nekrozu tespit edildi. 9 tübüler atrofi ve interstisyel fibrozis, 6 kalsinörin inhibitörü ilaç toksisitesi ve 7 polyomavirüs nefropatisi tanısı verildi. Ortalama kreatinin 2,58 ± 1,1 mg/dl idi. Proteinüri değerleri 83-12600 mg/gün ve ortalama proteinüri 2142 ± 2619 mg/gün idi. Proteinürinin 1000 mg/gün' den azında 2 akut AAR, 3 kronik aktif AAR, 21 akut THAR-borderline, 7 kronik aktif THAR ve diğer grubunda 12 biyopsi vardı. Proteinürinin 1000-3500 mg/gün arasında 5'i kronik aktif AAR, 2 akut THAR-borderline, 5 kronik aktif THAR ve diğer grupta 11 biyopsi vardı. 3500 mg/gün üzerindeki proteinüri, 2 kronik aktif AAR, 4 akut THAR-borderline, 8 kronik aktif THAR ve diğer grupta 7 biyopsi vardı. Rejeksiyon, rejeksiyon olmayan ve polyomavirüs nefropatisi olarak üç gruba ayırdığımız zaman proteinüri açısından istatistiksel olarak anlamlı bir fark rejeksiyon olmayan grup ve polyomavirüs nefropatisi grubu arasında çıktı.Sonuç: Renal allogreftte görülen disfonksiyon ve proteinüriye farklı tanı yaklaşımı nedeniyle renal allogreft biyopsilerinin tanıları merkezden merkeze farklılık gösterebilir

Anahtar Kelimeler:

Proteinüri, Rejeksiyon, Böbrek nakil biyopsisi

The Relationship Between Histopathological and Laboratory Findings in Kidney Transplant Recipients

Objective: In this retrospective study, we aimed to clarify the reasons for high creatinine levels and proteinuria in kidney transplants.Material and Methods: The research data were obtained from patient files and the hospital database.Results: Ninety-two patients, consisting of 24 females and 68 males, were biopsied. Histopathological examination of the biopsy samples showed borderline changes in 20 patients, acute antibody-mediated rejection AMR in two, chronic active AMR in 10, acute T-cell-mediated rejection TCMR in seven, recurrence of the primary disease or de novo glomerulonephritis in eight, coagulation necrosis in one, tubular atrophy and interstitial fibrosis in nine, calcineurin inhibitor drug toxicity in six, and polyomavirus nephropathy in seven. Average creatinine was 2.58±1.1 mg/dl. The proteinuria levels ranged from 83 to 12600 mg/day with the average value being 2142±2619 mg/day. Among the patients with a proteinuria value of less than 1000 mg/day, two had acute AMR, three chronic active AMR, 21 acute TCMR-borderline, and seven chronic active TCMR, and 12 biopsies revealed other causes. For the 1000-3500 mg/day proteinuria group, five chronic active AMR, two acute TCMRborderline, and five chronic active TCMR were identified, and 11 biopsies indicated other causes. Lastly, of the patients with a proteinuria level of greater than 3500 mg/day, two had chronic active AMR, four acute TCMR-borderline, and eight chronic active TCMR, and seven biopsies revealed other conditions. Conclusion: Diagnosis of renal allograft biopsies may vary from one center to another due to

Keywords:

Proteinuria, Rejection, Renal Transplant Biopsy,

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1. Cooper JE, Wiseman AC. Acute kidney injury in kidney transplantation. Curr Opin Nephrol Hypertens 2013; 22(6): 698-703.
2. Wiebe C, Nickerson P. Posttransplant monitoring of de novo human leukocyte antigen donor-specific antibodies in kidney transplantation. Curr Opin Organ Transplant 2013; 18(4):470-7.
3. Solez K, Racusen LC. The Banff classification revisited. Kidney Int 2013; 83(2):201-6.
4. Mehta RL, Kellum JA, Shah SV, Molitoris BA, Ronco C,Warnock DG, Levin A. Acute Kidney Injury Network: Report of an initiative to improve outcomes in acute kidney injury. Crit Care 2007; 11(2):R31.
5. Humar A, Johnson EM, Payne WD, Wrenshall L, Sutherland DE, Najarian JS, Gillingham KJ, Matas AJ. Effect of initial slow graft function on renal allograft rejection and survival. Clin Transplant 1997; 11(6):623-7.
6. Siedlecki A, Irish W, Brennan DC. Delayed graft function in the kidney transplant. Am J Transplant 2011; 11: 2279- 96.
7. Pratschke J, Dragun D, Hauser IA, Horn S, Mueller TF, Schemmer P, Thaiss F. Immunological risk assessment: The key to individualized immunosuppression after kidney transplantation. Transplant Rev 2016; 30(2):77- 84.
8. Guo H, Lin Z, Zhang W, Ming CS, Chen ZS, Zeng FJ, Liu B, Jiang JP, Gong NQ, Wei L, Shi HB, DU DF, Chen ZH, Chen XP. Histopathologic analysis of 1500 renal allograft biopsies. Zhonghua Yi Xue Za Zhi 2011; 91(8): 520-3.
9. El-Zoghby ZM, Stegall MD, Lager DJ, Kremers WK, Amer H, Gloor JM, Cosio FG. Identifying specific causes of kidney allograft loss. Am J Transplant 2009; 9(3):527- 35.
10. Arias-Cabrales C, Redondo-Pachón D, Pérez-Sáez MJ, Gimeno J, Sánchez-Güerri I, Bermejo S, Sierra A, Burballa C, Mir M, Crespo M, Pascual J. Renal graft survival according to Banff 2013 classification in indication biopsies. Nefrologia 2016; 36(6):660-6.
11. Sis B, Jhangri GS, Riopel J, Chang J, de Freitas DG, Hidalgo L, Mengel M, Matas A, Halloran PF. A new diagnostic algorithm for antibody-mediated microcirculation inflammation in kidney transplants. Am J Transplant 2012; 12(5):1168-79.
12. Amer H, Fidler ME, Myslak M, Morales P, Kremers WK, Larson TS, Stegall MD, Cosio FG. Proteinuria after kidney transplantation, relationship to allograft histology and survival. Am J Transplant 2007; 7(12):2748-56.
13. Sun Q, Jiang S, Li X, Huang X, Xie K, Cheng D, Chen J, Ji S, Wen J, Zhang M, Zeng C, Liu Z. The prevalence of immunologic injury in renal allograft recipients with de novo proteinuria. PLoS One 2012; 7(5):e36654.
14. Sis B, Mengel M, Haas M, Colvin RB, Halloran PF, Racusen LC, Solez K, Baldwin WM 3rd, Bracamonte ER, Broecker V, Cosio F, Demetris AJ, Drachenberg C, Einecke G, Gloor J, Glotz D, Kraus E, Legendre C, Liapis H, Mannon RB, Nankivell BJ, Nickeleit V, Papadimitriou JC, Randhawa P, Regele H, Renaudin K, Rodriguez ER, Seron D, Seshan S, Suthanthiran M, Wasowska BA, Zachary A, Zeevi A. Banff ’09 meeting report: Antibody mediated graft deterioration and implementation of Banff working groups. Am J Transplant 2010; 10(3):464-71.