Department of Histopatholology, Post Graduate Institute of Medical Education and Research, Chandigarh, India.
Transpl Int. 2014 Aug;27(8):784-92. doi: 10.1111/tri.12331. Epub 2014 May 24.
Glomerular diseases of the transplanted kidney are the most important cause of poor long- term outcome. The estimation of the magnitude of this problem and an elucidation of pathogenic mechanism is essential for improvement of graft survival. This study from the Indian subcontinent aims (i) to determine the incidence of transplant glomerulopathy (TG) and thrombotic microangiopathy (TMA) in a large cohort of indicated renal transplant biopsies, (ii) to evaluate the histological and ultrastructural features of TG and TMA, and (iii) to assess the relationship between the two glomerular lesions. Of a total of 1792 indication renal transplant biopsies received over 5 years (2006-2010), 266 biopsies (of 249 patients) had significant glomerular pathology and were further analyzed along with immunofluorescence, electron microscopy (EM), and C4d immunohistochemistry. TG is the most common glomerular lesion followed by TMA seen in 5.97% and 5.08% of allograft biopsies, respectively, which constitutes 40.23% and 34.2% of biopsies with significant glomerular lesions. Pathologic antibody-mediated rejection (AMR) is associated with both TG and TMA in 71% and 46.5%, respectively. A coexistent TG was found in 18.4% of biopsies with TMA. Endothelial swelling with subendothelial widening, a feature of TMA, is also seen in early TG by EM. Our findings support the concept that TG evolves from a smoldering TMA of various causes.
移植肾肾小球疾病是影响长期预后的最重要原因。评估该问题的严重程度并阐明发病机制对于提高移植物存活率至关重要。这项来自印度次大陆的研究旨在：(i) 在大量经指示的肾移植活检中确定移植肾小球病（TG）和血栓性微血管病（TMA）的发生率；(ii) 评估 TG 和 TMA 的组织学和超微结构特征；(iii) 评估两种肾小球病变之间的关系。在 5 年期间（2006-2010 年）共收到 1792 例指示性肾移植活检中，有 266 例（249 例患者）活检有明显的肾小球病变，进一步进行了免疫荧光、电子显微镜（EM）和 C4d 免疫组化分析。TG 是最常见的肾小球病变，其次是 TMA，分别见于 5.97%和 5.08%的同种异体移植物活检，占有明显肾小球病变的活检的 40.23%和 34.2%。病理性抗体介导的排斥反应（AMR）与 TG 和 TMA 分别相关，占比为 71%和 46.5%。在 18.4%的 TMA 活检中发现同时存在 TG。在 EM 中，TMA 的特征是内皮肿胀伴内皮下增宽，也可见于早期 TG。我们的研究结果支持这样的概念，即 TG 是由各种原因引起的潜伏性 TMA 演变而来。
