Alperovich Gabriela, Maldonado Rafael, Moreso Francesc, Fulladosa Xavier, Grinyó Josep M, Serón Daniel
Nephrology Department, Hospital Universitari de Bellvitge, Barcelona, Spain.
Am J Transplant. 2004 Apr;4(4):650-4. doi: 10.1111/j.1600-6143.2004.00392.x.
The aim of the study was to evaluate the evolution of glomerular volume 4 months after transplantation. Mean glomerular volume (Vg) was estimated according to the Weibel and Gomez method in a donor and a protocol biopsy done at 139 +/- 58 d in 41 stable grafts. Biopsies were also evaluated according to the Banff schema. Vg increased after transplantation from 4.1 +/- 1.4 to 5.1 +/- 2.4 x 10(6) micro3 (p=0.02). In patients with chronic allograft nephropathy in the protocol biopsy (n=14), the Vg enlargement was -0.3 +/-x 10(6) micro3 while in patients without chronic allograft nephropathy (n=27), glomerular enlargement was 1.6 +/- 2.1 x 10(6) micro3 (p=0.01). There was a negative association between glomerular volume in the donor biopsy and glomerular enlargement after transplantation (R=- 0.34, p=0.03). Multivariate regression analysis confirmed that Vg in the donor biopsy and chronic allograft nephropathy in the protocol biopsy were independent predictors of glomerular enlargement after transplantation (R=0.48, p=0.01). Moreover, Vg in the protocol biopsy correlated with creatinine clearance at the time of biopsy (R=0.38, p=0.01). Glomeruli enlarge after transplantation and glomerular volume after 4 months correlates with creatinine clearance, suggesting that glomerular enlargement is a necessary condition for renal adaptation to the recipient. Glomerular enlargement is impaired in patients with chronic allograft nephropathy.
本研究的目的是评估移植后4个月肾小球体积的变化情况。采用韦贝尔和戈麦斯方法，对41例稳定移植受者在移植后139±58天进行供体肾活检及方案规定的活检，以估算平均肾小球体积（Vg）。活检还根据班夫标准进行评估。移植后Vg从4.1±1.4增加至5.1±2.4×10⁶立方微米（p = 0.02）。在方案规定活检时患有慢性移植肾肾病的患者（n = 14）中，Vg增大为 -0.3±×10⁶立方微米，而在无慢性移植肾肾病的患者（n = 27）中，肾小球增大为1.6±2.1×10⁶立方微米（p = 0.01）。供体活检时的肾小球体积与移植后肾小球增大之间存在负相关（R = -0.34，p = 0.03）。多变量回归分析证实，供体活检时的Vg和方案规定活检时的慢性移植肾肾病是移植后肾小球增大的独立预测因素（R = 0.48，p = 0.01）。此外，方案规定活检时的Vg与活检时的肌酐清除率相关（R = 0.38，p = 0.01）。移植后肾小球会增大，4个月后的肾小球体积与肌酐清除率相关，这表明肾小球增大是肾脏适应受者的必要条件。慢性移植肾肾病患者的肾小球增大受损。
