Prasad Narayan, Gupta Pallav, Jain Manoj, Bhadauria Dharmendra, Gupta Amit, Sharma Raj Kumar, Kaul Anupama
Department of Nephrology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Pin, India, 226014.
Exp Clin Transplant. 2013 Jun;11(3):215-21. doi: 10.6002/ect.2012.0193.
Despite increased use of diabetogenic immunosuppressive drugs and increased incidence of new-onset diabetes after transplant in renal allograft recipients, there are few case studies on the subject of de novo allograft diabetic nephropathy and interstitial fibrosis/tubular atrophy without specific glomerular changes. We sought to study the outcomes of allograft diabetic nephropathy and interstitial fibrosis/tubular atrophy without specific glomerular changes in patients with new-onset diabetes after transplant.
We reviewed the case records of all new-onset diabetes after transplant patients who underwent graft biopsy for graft dysfunction from 1992 to 2010. We analyzed the clinical characteristics and outcomes of new-onset diabetes after transplant patients with de novo allograft diabetic nephropathy and interstitial fibrosis/tubular atrophy without specific glomerular changes.
Of the 1989 recipients, 421 patients developed new-onset diabetes after transplant and 26 underwent graft biopsy. Of the 26 patients, 9 had histopathologic evidence of de novo allograft diabetic nephropathy, and 17 had interstitial fibrosis/tubular atrophy without specific glomerular changes. The mean duration from transplant to developing novo allograft diabetic nephropathy was 115.2 months (range, 33-192 mo), and from developing new-onset diabetes after transplant to allograft diabetic nephropathy, was 109.66 months (range, 27-188.4 mo). Of the 9 patients with de novo allograft diabetic nephropathy, 3 died (33.3%), 2 reached end-stage renal disease (22.2%), and 4 remained stable (44.4%). Of the 17 with interstitial fibrosis/tubular atrophy, 2 died (11.7%), 5 developed end-stage renal disease (29.4%), and 10 remained stable on triple immunosuppression and insulin therapy during follow-up (58.8%).
De novo allograft diabetic nephropathy is a significant cause of graft and patient loss in renal allograft recipients who develop new-onset diabetes after transplant.
尽管肾移植受者中致糖尿病性免疫抑制药物的使用增加，且移植后新发糖尿病的发病率上升，但关于新发移植肾糖尿病肾病以及无特定肾小球改变的间质纤维化/肾小管萎缩的病例研究却很少。我们试图研究移植后新发糖尿病患者中无特定肾小球改变的移植肾糖尿病肾病和间质纤维化/肾小管萎缩的结局。
我们回顾了1992年至2010年因移植肾失功而接受移植肾活检的所有移植后新发糖尿病患者的病例记录。我们分析了新发移植肾糖尿病肾病以及无特定肾小球改变的间质纤维化/肾小管萎缩的移植后新发糖尿病患者的临床特征和结局。
在1989名受者中，421例患者移植后出现新发糖尿病，其中26例接受了移植肾活检。在这26例患者中，9例有新发移植肾糖尿病肾病的组织病理学证据，17例有间质纤维化/肾小管萎缩但无特定肾小球改变。从移植到发生新发移植肾糖尿病肾病的平均时间为115.2个月（范围33 - 192个月），从移植后发生新发糖尿病到移植肾糖尿病肾病的时间为109.66个月（范围27 - 188.4个月）。在9例新发移植肾糖尿病肾病患者中，3例死亡（33.3%），2例进入终末期肾病（22.2%），4例病情稳定（44.4%）。在17例间质纤维化/肾小管萎缩患者中，2例死亡（11.7%），5例发展为终末期肾病（29.4%），10例在随访期间接受三联免疫抑制和胰岛素治疗病情稳定（58.8%）。
新发移植肾糖尿病肾病是移植后发生新发糖尿病的肾移植受者移植肾和患者丢失的重要原因。
