Torbenson M, Randhawa P
Department of Pathology, The Johns Hopkins Hospital, Baltimore, MD, USA.
Hum Pathol. 2001 Dec;32(12):1388-91. doi: 10.1053/hupa.2001.29669.
Intimal arteritis in the renal allograft has a well-documented adverse effect on graft outcome. In contrast, venulitis is currently considered an innocuous finding, based largely on observations of thin-walled intermediary venules. Arcuate and interlobular veins have not been studied specifically. These veins have well-developed muscular walls, and inflammation at this level (phlebitis) could significantly alter renal hemodynamics. We studied the clinicopathologic correlates of arcuate and interlobular phlebitis in 31 renal allograft biopsy specimens. Phlebitis was seen in conjunction with borderline changes suggestive of acute cellular rejection (13 cases), or acute rejection Banff grade 1A (7 cases), Banff grade 1B (6 cases), Banff grade 2A (4 cases), and Banff grade 2B (1 case). Clinical follow-up (average 323 +/- 460 days) showed no adverse effects of phlebitis as judged by temporal changes in serum creatinine and the grade of chronic allograft nephropathy in follow-up biopsies. Thus it appears that arcuate and interlobular phlebitis in allograft biopsy specimens does not add prognostic information beyond that provided by conventional Banff criteria. However, this lesion frequently coexists with changes suggestive or diagnostic of acute cellular rejection, and intimal arteritis may be seen concurrently in up to 16% of cases.
肾移植受者的内膜动脉炎对移植肾结局的不良影响已有充分记录。相比之下，静脉炎目前被认为是一种无害的表现，这主要基于对薄壁中间微静脉的观察。弓状静脉和小叶间静脉尚未得到专门研究。这些静脉具有发育良好的肌层，该水平的炎症（静脉炎）可能会显著改变肾脏血流动力学。我们研究了31例肾移植活检标本中弓状静脉和小叶间静脉炎的临床病理相关性。静脉炎与提示急性细胞排斥反应的临界变化（13例）、或急性排斥反应Banff 1A级（7例）、Banff 1B级（6例）、Banff 2A级（4例）和Banff 2B级（1例）同时出现。临床随访（平均323±460天）显示，根据血清肌酐的时间变化和随访活检中慢性移植肾肾病的分级判断，静脉炎没有不良影响。因此，移植肾活检标本中的弓状静脉和小叶间静脉炎似乎并未提供超出传统Banff标准的预后信息。然而，这种病变常与提示或诊断急性细胞排斥反应的变化同时存在，高达16%的病例可能同时出现内膜动脉炎。
