Japanese Red Cross Nagoya Daini Hospital, Kidney Disease Center, Nagoya, Aichi, Japan.
Clin Transplant. 2011 Jul;25 Suppl 23:23-7. doi: 10.1111/j.1399-0012.2011.01474.x.
Calcineurin inhibitors (CNI) have been commonly used as pivotal immunosuppressive agents to renal transplant recipients and have contributed significantly to improving short-term allograft survival. However, long-term administration of CNI may cause an adverse effect on kidney function, known as chronic nephrotoxicity. Chronic CNI nephrotoxicity (CNI-NT) shows characteristic histopathological findings that involve arteriolar hyalinosis. Recently, the term alternative arteriolar hyalinosis (aah) is used to discriminate CNI-specific arteriolar hyaline deposition from non-specific arteriolar hyalinosis. We studied whether arteriolar vacuolization represents an early lesion of aah as a predictor of CNI-NT. We retrospectively studied the 79 patients under treatment with a CNI immunosuppressant, who underwent living-related renal transplantation (RTx) from January 2007 to March 2009. We examined serial protocol graft biopsies at one h, one, six, and 12 months after RTx. We classified histological findings into two groups on the basis of aah lesion (with or without aah) in serial biopsies for 12 months. Arteriolar vacuolization was more frequently observed in the aah group than in the non-aah group with a significant difference. Arteriolar vacuolization was found even in the one-h biopsy specimens, indicating a non-specific histopathological finding. But in the aah group, arteriolar vacuolization tended to be more frequently observed later on. Aah can be a predictor of CNI-NT.
钙调磷酸酶抑制剂 (CNI) 已被广泛用作肾移植受者的关键免疫抑制剂，并显著提高了短期移植物存活率。然而，长期使用 CNI 可能会对肾功能产生不良影响，即慢性肾毒性。慢性 CNI 肾毒性 (CNI-NT) 表现出特征性的组织病理学发现，涉及小动脉玻璃样变性。最近，术语替代小动脉玻璃样变性 (aah) 用于区分 CNI 特异性小动脉玻璃样沉积与非特异性小动脉玻璃样变性。我们研究了小动脉空泡化是否代表 aah 的早期病变，作为 CNI-NT 的预测指标。我们回顾性研究了 79 例接受 CNI 免疫抑制剂治疗的患者，这些患者于 2007 年 1 月至 2009 年 3 月期间接受活体亲属肾移植 (RTx)。我们在 RTx 后 1 小时、1 个月、6 个月和 12 个月检查了连续的协议移植活检。我们根据 12 个月的连续活检中 aah 病变（有或无 aah）将组织学发现分为两组。在 aah 组中，小动脉空泡化比非 aah 组更常见，差异具有统计学意义。甚至在 1 小时的活检标本中也发现了小动脉空泡化，这是一种非特异性的组织病理学发现。但在 aah 组中，小动脉空泡化后来更常观察到。Aah 可能是 CNI-NT 的预测指标。
