Kambham Neeraja, Nagarajan Suja, Shah Sheryl, Li Li, Salvatierra Oscar, Sarwal Minnie M
Department of Pathology, Stanford, CA 94305-5324, USA.
Clin J Am Soc Nephrol. 2007 Jan;2(1):135-42. doi: 10.2215/CJN.01320406. Epub 2006 Nov 8.
Calcineurin inhibitor toxicity (CNIT) is an important cause of chronic allograft nephropathy (CAN), but clinically relevant, diagnostic pathologic criteria remain to be defined. A semiquantitative, clinically correlative CNIT scoring system was developed and validated by pathologic analyses of 254 renal transplant biopsies that were obtained from 50 consecutive pediatric renal transplant recipients. Differentially weighted pathologic criteria (glomerulosclerosis, tubular atrophy, arteriolar medial hyaline, and tubular isometric vacuolization) contributed to the composite CNIT model score. Unlike other established pathology chronicity scores, such as the chronic allograft damage index, Banff, and modified Banff, the CNIT score was highly correlated with future graft function. The 3-mo CNIT score correlated significantly with 12 mo (P = 0.021) and 24 mo (P = 0.03) calculated creatinine clearance. Arteriolar medial hyalinosis seems to be the most important factor contributing to the clinical impact of the CNIT score.
钙调神经磷酸酶抑制剂毒性（CNIT）是慢性移植肾肾病（CAN）的一个重要原因，但临床相关的诊断病理标准仍有待确定。通过对50例连续儿科肾移植受者的254份肾移植活检标本进行病理分析，开发并验证了一种半定量、与临床相关的CNIT评分系统。不同加权的病理标准（肾小球硬化、肾小管萎缩、小动脉中层玻璃样变和肾小管等距空泡化）构成了综合CNIT模型评分。与其他已确立的病理慢性评分，如慢性移植肾损伤指数、班夫标准和改良班夫标准不同，CNIT评分与未来移植肾功能高度相关。3个月时的CNIT评分与12个月（P = 0.021）和24个月（P = 0.03）计算的肌酐清除率显著相关。小动脉中层玻璃样变似乎是导致CNIT评分临床影响的最重要因素。
